Evaluation of knowledge, attitudes and perceptions regarding cancer screening in relatives of patients operated on due to gastric or colorectal cancer

In Türkiye, a total of 129,672 cancer-related deaths were recorded in 2022, with lung (29.7%; n=38,505), colorectal (9.0%; n=11,698), and gastric cancers (8.1%; n=10,457) ranking as the leading causes of cancer mortality. Gastric and colorectal cancers are significant contributors to cancer-related mortality in Türkiye. This study aimed to evaluate the knowledge, attitudes, and perceptions regarding cancer screenings among first-degree relatives of patients who underwent surgery due to gastric or colorectal cancer, considering that these individuals may carry higher environmental and genetic risk factors than the general population. MATERIALS AND METHODS: This research was conducted as a descriptive, cross-sectional study. Patients who had undergone surgery for gastric or colorectal cancer at Bezmialem Vakıf University Hospital between 2020 and 2024 were retrospectively screened, and their contact information was retrieved from the hospital information system. A total of 170 first-degree relatives who met the inclusion criteria—50 related to gastric cancer patients and 120 to colorectal cancer patients—were included in the study. Data collection tools consisted of a sociodemographic information form and a 100-item survey, which included the "Attitudes Toward Cancer Screenings Scale" developed by Yıldırım Öztürk EN et al. and the "Cancer Screening Perception Scale" developed by Mahmood et al. (2016), with Turkish validity and reliability provided by Yılmaz M. and Bozkurt A. (2024). The survey was administered either via phone or face-to-face during visits to the General Surgery outpatient clinic. Data were subjected to statistical analysis, with p<0.05 considered statistically significant. RESULTS: Of the participants, 29.4% (n=50) were relatives of patients who had undergone surgery for gastric cancer, and 70.6% (n=120) were relatives of patients operated on for colorectal cancer. Among the participants, 37% (n=63) were sons, 32% (n=56) were daughters, and 17.6% (n=30) were spouses of the patients. The mean age was 46.6 ± 10.6 years; 50.6% (n=86) were male, 75.9% (n=129) were married, and 37.6% (n=64) were university graduates. Female participants demonstrated significantly higher levels of knowledge regarding the National Cancer Screening Program compared to males. Women were more likely to have previously heard of "Cancer Early Diagnosis, Screening and Education Centers" (p=0.022), to believe they had knowledge of cancer screenings (p<0.001), to know that breast and cervical cancers are screened (p<0.001; p<0.001), to be aware of the age ranges for breast, cervical, and colorectal cancer screenings (p<0.001; p<0.001; p=0.04), to be familiar with mammography and Pap smear tests (p<0.001; p<0.001), and to know the screening intervals for breast and cervical cancer (p<0.001; p<0.001). Scores from the Cancer Screening Perception Scale and the Attitudes Toward Cancer Screenings Scale were analyzed. Women had significantly higher median scores for perceived benefits of cancer screenings and attitudes toward screenings compared to men (p=0.023; p=0.007). Married individuals had higher cue-to-action scores than single participants (p=0.045). Participants with primary or secondary education had higher perceived sensitivity, perceived barriers, and cue-to-action scores than those with a university degree or higher (p<0.001; p=0.003; p=0.031). University graduates had significantly higher median scores on the Attitudes Toward Cancer Screenings Scale than those with lower education levels (p=0.002). Self-employed individuals had higher perceived barriers scores compared to white-collar workers (p=0.042), while white-collar participants had higher attitude scores (p=0.009). Participants with household incomes at or below minimum wage had higher perceived barriers scores than those with higher income (p=0.016). Participants not involved in caregiving for the patient had lower perceived severity scores compared to those who were partially or fully responsible for caregiving (p<0.001). When comparing the relatives of patients with gastric and colorectal cancer, median scores for perceived benefits and attitudes toward cancer screenings were significantly higher in the colorectal cancer group (p=0.028; p<0.001). No significant differences were found between the two groups regarding perceived severity, sensitivity, barriers, or cues to action (p=0.792; p=0.055; p=0.234; p=0.200). While 84% of participants reported not having knowledge about cancer screenings, 51.2% stated that they had previously undergone at least one screening. Only 36.7% of relatives of colorectal cancer patients had participated in colorectal cancer screening. Comparing screening participation between relatives of gastric and colorectal cancer patients, no statistically significant differences were found for breast and colorectal screenings (p=0.637; p=0.063). However, participation in cervical cancer screening was significantly higher among relatives of colorectal cancer patients (p=0.002). CONCLUSION: Due to the earlier implementation of breast and cervical cancer screenings in the National Cancer Screening Program, female participants demonstrated higher levels of knowledge, perceived benefit, and positive attitudes toward screenings than males. Being married, having higher education and income levels, and providing care for the cancer patient were associated with more favorable perceptions and attitudes toward screenings. Relatives of colorectal cancer patients exhibited more favorable perceptions and attitudes than those of gastric cancer patients. Although cervical cancer screening participation was significantly higher among the colorectal cancer group, no significant differences were found for breast and colorectal screenings. The elevated rate of cervical cancer screening in the colorectal group may indicate that they possess more knowledge about screening practices. However, the low screening participation even among those with a family history of colorectal cancer highlights the need for more targeted and effective intervention strategies to improve awareness and knowledge regarding cancer screenings. Keywords: Gastric Cancer, Colorectal Cancer, First-Degree Relatives, Cancer Screening, Perception, Attitude