Email updates

Keep up to date with the latest news and content from BMC Cancer and BioMed Central.

Open Access Research article

Knowledge and attitudes of primary healthcare patients regarding population-based screening for colorectal cancer

Maria Ramos1*, Maria Llagostera2, Magdalena Esteva3, Elena Cabeza1, Xavier Cantero2, Manel Segarra2, Maria Martín-Rabadán4, Guillem Artigues1, Maties Torrent5, Joana Maria Taltavull3, Joana Maria Vanrell1, Mercè Marzo2 and Joan Llobera3

Author Affiliations

1 Public Health Department, Balearic Islands Health Department, Spain

2 Costa de Ponent Primary Health Care Department, Catalonian Health Institut, Barcelona, Spain

3 Mallorca Primary Health Care Service, Balearic Island Health Service, Spain

4 Ibiza Health Care Service, Balearic Island Health Service, Spain

5 Menorca Health Care Service, Balearic Island Health Service, Spain

For all author emails, please log on.

BMC Cancer 2011, 11:408  doi:10.1186/1471-2407-11-408

Published: 25 September 2011



The aim of this study was to assess the extent of knowledge of primary health care (PHC) patients about colorectal cancer (CRC), their attitudes toward population-based screening for this disease and gender differences in these respects.


A questionnaire-based survey of PHC patients in the Balearic Islands and some districts of the metropolitan area of Barcelona was conducted. Individuals between 50 and 69 years of age with no history of CRC were interviewed at their PHC centers.


We analyzed the results of 625 questionnaires, 58% of which were completed by women. Most patients believed that cancer diagnosis before symptom onset improved the chance of survival. More women than men knew the main symptoms of CRC. A total of 88.8% of patients reported that they would perform the fecal occult blood test (FOBT) for CRC screening if so requested by PHC doctors or nurses. If the FOBT was positive and a colonoscopy was offered, 84.9% of participants indicated that they would undergo the procedure, and no significant difference by gender was apparent. Fear of having cancer was the main reason for performance of an FOBT, and also for not performing the FOBT, especially in women. Fear of pain was the main reason for not wishing to undergo colonoscopy. Factors associated with reluctance to perform the FOBT were: (i) the idea that that many forms of cancer can be prevented by exercise and, (ii) a reluctance to undergo colonoscopy if an FOBT was positive. Factors associated with reluctance to undergo colonoscopy were: (i) residence in Barcelona, (ii) ignorance of the fact that early diagnosis of CRC is associated with better prognosis, (iii) no previous history of colonoscopy, and (iv) no intention to perform the FOBT for CRC screening.


We identified gaps in knowledge about CRC and prevention thereof in PHC patients from the Balearic Islands and the Barcelona region of Spain. If fears about CRC screening, and CRC per se, are addressed, and if it is emphasized that CRC is preventable, participation in CRC screening programs may improve.

Colorectal neoplasm; population-based screening; fecal occult blood test; primary healthcare; attitude; knowledge