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Knowledge and Attitudes of Medical Students Regarding Colorectal Cancer Screening in Lome

Aklesso Bagny1,2*, Lidawu Roland Moise Kogoe1, Late Mawuli Lawson-ananissoh1,2, Yeba Laconi Kaaga1, Debehoma Venceslas Redah1, Henoc Gbolou1, Yves Kanake1

1Service of Gastroenterology, Teaching hospital campus, Lome, Togo;
2 Department of Gastroenterology, University of Lomé, Togo.

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http: //creativecommons.org/licenses/by-nc/4.0/

Correspondence to: Dr Aklesso Bagny, Gastroenterologist and Hepatologist, Service of Gastroenterology, Teaching hospital Campus, Lome, Togo.
Email: ybagny@yahoo.fr
Telephone: +22890125159

Received: May 20, 2021
Revised: May 30, 2021
Accepted: June 2, 2021
Published online: June 21, 2021

ABSTRACT

Aim: The objective of this study was to evalute among medical students of the university of lome the knowledge and practice about colorectal cancer screening.

Method: A cross-sectional study was conducted from March to May 2020 among medical students of the university of Lome. The data were analyzed by STATA 2013 software.

Results: The fecal immunochemical test and Fecal occult blood was known by 51.5% of the respondents. students who were unaware of the existence of these tests were 99.1% undergraduate students. The variables statistically associated with the knowledge of these tests were age over 22 years (p < 0.001) and the effectiveness of an internship in a department of oncology or digestive pathology (p < 0.001). the majority of students (88.1%) knew the frequency of performing these tests, and 28.4% had already requested at least one of these tests, either as part of a screening (93.5%), or in front of a symptomatology of lower gastrointestinal tract (6.4%). Colonoscopy was unknown by 52% of the students. Undergraduate students represented 97.3% of the group not aware of the existence of colonoscopy. The only variable associated with knowledge of colonoscopy was the effectiveness of an internship in an oncology or digestive pathology department (p < 0.001).

Conclusion: The data of our study would suggest that there remain areas that need improvement and that there are several implications for future curriculum development in preventative medicine in general and colorectal cancer screening in particular.

Key words: Knowledge; Practice; Medical students; Colorectal cancer screening; Togo

© 2021 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Bagny A, Kogoe LRM, Lawson-ananissoh LM, Kaaga YL, Redah DV, Gbolou H, Kanake Y. Knowledge and Attitudes of Medical Students Regarding Colorectal Cancer Screening in Lome. Journal of Gastroenterology and Hepatology Research 2021; 10(3):3520-3523 Available from: URL: http://www.ghrnet.org/index.php/joghr/article/view/3170

INTROUDUCTION

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females, with worldwide over 1.4 million new cases and nearly 700,000 deaths reported in 2012[1]. This cancer affects the colon in 71% of cases, and the rectum in 29% of cases[2]. It ranks third in terms of cancer frequency and second in terms of cancer deaths for all sexes[3]. Its frequency shows significant variations. Indeed, the frequency may be distributed according to two geographical areas: on the one hand, Western countries with high incidence rates; on the other hand, developing countries, where rates are relatively low[4]. The American Cancer Society (ACS) recommends starting screening at age 45. The tests recommended by the ACS for this screening are grouped into two: visual/structural tests and stool tests. The visual/structural tests include a colonoscopy every 10 years, a coloscan every 5 years and a flexible sigmoidoscopy every 5 years. Fecal-based tests include a fecal immunochemical test(FIT) every year, a guaiac-based fecal occult blood test (gFOBT) every year, and a multitarget DNA (MT-DNA or FIT DNA) test every 3 years[5]. Colonoscopy is indicated if one of the fecal tests or flexible sigmoidoscopy or coloscanner becomes positive[6]. In Togo, a study conducted from 2009 to 2016 in the Department of Pathological Anatomy and Cytology of the Sylvanus Olympio University Hospital Center in Lome reported that colorectal cancers accounted for 4.8% of all cancers reported[7]. These cancers were often diagnosed at an advanced stage[8]. This delay in diagnosis is favoured on the one hand by the delay in consultation, and on the other hand by a misinterpretation of the signs of the onset of the disease by general practitioners. In our context of limited technical facilities, the best attitude remains prevention. General practitioners are the closest and most frequently in contact with the population[9]. We therefore felt it necessary to conduct this study with the aim of evaluate medical student’s knowledge and practice of CRC screening.

Patients and method

The present cross-sectional study was conducted at the faculty of medicine - University of Lome (Togo), among medical students from March to Mai 2020. A convenience sampling method was used in the recruitment of students. Informed consent was taken before filling the questionnaire. In the study, we included undergraduate medical and interns. The ethical approval was obtained from the Research Ethics Committee, of the faculty of medicine - University of Lome. The study questionnaire was adapted from surveys identified in the relevant literature. The results are expressed in frequencies and percentages for qualitative variables. Results are expressed in mean ±standard deviation, and independent t-test was conducted to compare the knowledge and practice scores between the differente degrees of medical students. The data was analyzed using the STATA 2013. Statistical significance was determined at p < 0.05.

RESULTS

A total of 982 medical students answered the questionnaire. The students were within the age range of 17-32 years (mean age of 21.96 ± 3.54 years). The majority of the participants were males (78.3%) and more than half (65.8%) of the participants were undergraduate surdents. The participants belonged to all academic years from first to 7th years (Table 1).

The fecal immunochemical test (FIT) and Fecal occult blood was known by 51.5% of the respondents. Respondents who were unaware of the existence of these tests were undergraduate students (p < 0.001). There was statistical difference between responses for students when analyzed by age (p < 0.001) and the effectiveness of an internship in a department of oncology or digestive pathology (p < 0.001) (Table 2). Most of the students (88.1%) knew the frequency of performing these tests, and Personal attitudes in regards to cancer screening shown that 28.4% had already requested at least one of these tests, either as part of a screening (93.5%) or in response to a low GI symptomatology (6.4%).

Prior to our study, colonoscopy was unknown to 52.% of the students surveyed. Undergraduate students represented 97.3% of the group not aware of the existence of colonoscopy. The percentage of individuals aware of colonoscopy was higher among females (p < 0.002), Postgraduate students (p < 0.001), and students who had completed an internship in an oncology or digestive pathology department (p < 0.001). Of these students, 76.6% knew the frequency of performing colonoscopy for people who have an increased risk of colorectal cancer. The only variable statistically associated with knowledge of colonoscopy was the effectiveness of an internship in an oncology or digestive pathology department (p < 0.001) (Table 3). Twenty-five point fifteen percent (25.15%) of our study population had previously requested colonoscopy, either in the presence of lower GI tract symptoms (69.6%) or in the presence of a positive fecal immunochemical test (FIT) and Fecal occult blood tests (21.5%).

Table 1 General characteristics of medical students.
  Effective Percentage (%)Mean+/-standard deviation
Age (years) 
Age  21.96+/-3.54
≤ 2251352.2 
> 2246947.8 
Gender 
Male76978.3 
Female21321.7 
Study cycle  
internship years33634.2 
undergraduate years64665.78 
Internship in oncology Or digestive pathology 
Yes21922.3 
No76377.6 

Table 2 Comparison of medical students knowledge regarding the fecal immunochemical test (FIT) and fecal occult blood.
  n/N%OR95%ICP-value
Sex0.08
Male368/76947.81- 
Female138/21364.81.4[0.13-1.55] 
Age ˂0.001
≤ 22 years54/51310.51- 
> 22 years452/46996.40.8[0.35-0.87] 
Study cycle <0.001
undergraduate years171/64626.51- 
Internship years335/33697.60.4[0.24-1.64] 
Internship in oncology Or digestive pathology ˂0.001
Yes219/2191001- 
No287/76337.60.8[0.34-0.83]  

Table 3 Comparison of medical students knowledge regarding the colonoscopy.
  n/N%OR 95%ICP-value
Sex <0.001
Male343/76944.61- 
Female128/21360.10.92[0.34-1.83]  
Age0.001
≤ 22 years27/5135.31- 
> 22 years444/46994.70.8[0.50-1.46] 
Study Cycle ˂0.001
undergraduate years137/64621.21 [2.24-4.76]  
Internship years334/33699.40.5 [0.85-2.61]  
Internship in oncology Or digestive departements ˂0.001
Yes212/21996.81- 
No259/76333.90.4 [0.19-0.73]  

DISCUSSION

Recognition of the importance of teaching prevention is not new[10]. US medical schools found that cancer prevention and detection were important topics in the medical school curriculum but more emphasis, time and resources were needed[11]. The objective of this study was to evaluate the knowledge and attitudes of medical students of the Faculty of Health Sciences of Lome regarding colorectal cancer screening. The choice to carry out our study among the students of the Faculty of Health Sciences was explained on the one hand by the fact that most of the knowledge of general practitioners is acquired during the years of training. Secondly, carrying out such a study with general practitioners as the study population would have required a multicentre collection in order to obtain a representative sample. Nevertheless, our study is still of interest, as it allows us to evaluate the knowledge of students in the Faculty of Health Sciences regarding colorectal cancer screening.

The participation rate in our survey was 60.9%, significantly lower than that reported by other similar studies[9,10]. This difference can be explained by the fact that the study took place at the height of the coronavirus pandemic, when the face-to-face courses were suspended, making it difficult to interview a maximum number of students; nevertheless, the sample size was representative of the target population.

The fecal immunochemical test (FIT) and Fecal occult blood were known by 51.5% of the students. This result is higher than that reported by El Fakir et al[12] in Morocco (6.7%), but significantly lower than those reported by the European series[13,14]. From these results, we can conclude that fecal immunochemical test (FIT) and Fecal occult blood are not well known in sub-saharian Africa because they are not used in current practice. Moreover, the majority of the students in our study were aware of these tests during clinical internships in oncology or digestive pathology departements. This finding explains the existence of a statistically significant relationship between knowledge of colorectal cancer screening with age and the completion of an internship in the above-mentioned services. Only 28.4% of the respondents had already requested at least one of these tests.This low prescription rate could be explained by a lack of awareness of the existence of the tests, and also by the fact that they are generally only requested in specialized services.

Colonoscopy was known by only 48% of the students surveyed. This lack of awareness of colonoscopy as a screening examination was also found in the study by Okon et al[15] in Côte d’Ivoire, and by Fakir et al[12] in Morocco, who reported a knowledge rate of 0.4% and 14.8% respectively. However, in the study by Bulliard et al [13], 68% of respondents were aware of colonoscopy as a screening test for colorectal cancer. From these results, we can conclude that colonoscopy is not well known in our country because it is not used in current practice. Moreover, the majority of the students in our study were aware of its existence only during clinical internships in oncology or digestive pathology departments. This result explains the existence of a statistically relationship between knowledge of colorectal cancer screening and the effectiveness of an internship in an oncology or digestive pathology departments. Only 25.1% of the respondents had already requested at least one colonoscopy as part of a colorectal cancer screening. This low rate of medical students practice could be explained by a lack of awareness of the existence of this morphological examination.

Conclusion

The data of our study would suggest that there remain areas that need improvement and that there are several implications for future curriculum development in preventative medicine in general and colorectal cancer screening in particular.

Author’s contributions

Bagny Aklesso designed the study, write the protocol and corrected the manuscript; Dr Kogoe Lidawu Roland-Moïse managed analysis and discussion; Lawson-Ananissoh Laté Mawuli managed the literature searches; Dr Kaaga Laconi: managed the literature searches; Dr Redah Debehoma Venceslas: managed data collection; Dr Gbolou Henoc: managed data collection; Dr Kanake Yves: managed data collection

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