Abstract
Objective
We aimed to assess the level of knowledge and awareness regarding the need for screening of early gastrointestinal cancer among residents of Sunan Yugur Autonomous County in China.
Methods
In this cross-sectional study, we conducted a survey among permanent residents of Sunan Yugur Autonomous County from January 2020 to January 2023 using a questionnaire to obtain data on knowledge regarding early gastrointestinal cancer screening.
Results
The survey included 12,000 residents. Among participants, 62.30% (7476/12,000) were aware of the need for early gastrointestinal cancer screening. Awareness about the need for early gastrointestinal cancer screening differed significantly based on participants’ sex, age, level of education, area of residence, and ethnicity.
Conclusion
The level of awareness regarding the need for early gastrointestinal cancer screening was relatively low in our study population. The government and medical institutions should provide information and promote early gastrointestinal cancer screening in the region to improve the health status and quality of life among the Yugur people.
Introduction
Early gastrointestinal cancer refers to primary cancer of the digestive tract limited to the mucosal layer.1,2 The disease predominantly affects middle-aged and older adults, with high incidence and mortality rates.3,4 Clinically, early gastrointestinal cancer is classified as early esophageal cancer, early colorectal cancer, and early gastric cancer, depending on the site of the lesion.5,6 Early screening and diagnosis of gastrointestinal cancer are essential for improving prognosis. Previous studies have revealed a low level of knowledge and awareness regarding screening for early gastrointestinal cancer in China, especially in ethnic minority areas, posing a barrier to early diagnosis and treatment.7,8 We conducted a survey in Sunan Yugur Autonomous County, Gansu Province, a Yugur ethnic area, to assess knowledge and awareness regarding screening for early gastrointestinal cancer among this ethnic minority group.
Methods
General information
Sunan Yugur Autonomous County in Gansu Province, China is the sole ethnic minority area of the Yugur people. This region is characterized by a high altitude (1327–5564 m) and a cold climate. As of the end of 2022, a total of 39,283 residents were registered in the county, including 11,100 urban residents and 16,200 rural residents. In total, 22,300 people had paid employment.
In this study, we conducted a survey of permanent residents in Sunan Yugur Autonomous County from January 2020 to January 2023. The inclusion criteria were 1) registered permanent residents of Sunan Yugur Autonomous County; 2) normal mental status, fully conscious, and capable of understanding the questionnaire content; 3) age over 18 years; and 4) provided written informed consent. The exclusion criteria were major mental or cognitive impairment and difficulty understanding the questionnaire for any reason, including severe deafness. We de-identified all patient details.
Ethical approval was granted by the Ethics Committee of Zhangye People’s Hospital affiliated to Hexi University. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. 9
Data collection
In this cross-sectional study, we collected data using a structured questionnaire to assess knowledge and awareness regarding early gastrointestinal cancer screening. We collected basic information, including sex, age, home address, contact telephone number, level of education, and ethnicity. The questionnaire included 16 items on knowledge about early gastrointestinal cancer screening, including 12 single-choice questions and four multiple-choice questions (Table 1). The questionnaire was in electronic format, allowing participants to complete the survey online via a mobile phone or computer or in a face-to-face interview with research staff. The content, purpose, and completion method of the questionnaire were explained to individuals selected for this study. All respondents were required to complete the questionnaire independently. We intended to conduct a comprehensive survey of the population aged 18 and above within the territory. However, because Sunan Yugur Autonomous County comprises a vast land area, the survey was focused on residents in the settlement area (excluding herdsmen who grazed livestock away from home). We collected complete data from 12,000 residents living in the settlement area, with strong support from the local government and village officials. For residents who were unable to communicate in Chinese, were illiterate, or were unfamiliar with modern communication methods, a questionnaire was conducted in household follow-up with village officials, who helped respondents complete the questionnaire.
Questionnaire on knowledge about early gastrointestinal cancer.
Outcome measure
The primary outcome measure was awareness about the need for early gastrointestinal cancer screening, which we analyzed according to sex, age, education level, place of residence (rural or urban), occupation, and ethnicity.
Statistical analysis
The data were analyzed using IBM SPSS 23.0 (IBM Corp., Armonk, NY, USA). The results are expressed as frequency and percentage, and statistically significant differences in the levels of awareness between groups was assessed using chi-square tests. P < 0.05 was considered statistically significant.
Results
In total, 12,000 permanent residents of Sunan Yugur Autonomous County participated in the survey. Respondents’ characteristics were as follows: 6347 men (52.89%) and 5653 women (47.11%); age <25 years (16.54%), 25 to 44 years (23.78%), 45 to 64 years (52.73%), and ≥65 years (6.95%); education level primary school or below (8.63%), middle school (47.28%), high school (32.47%), and junior college or above (11.63%); registered residence: rural (61.32%) and urban (38.68%); occupation: government employee (8.63%), commercial sector (28.55%), agricultural and animal husbandry worker (37.81%), industrial and construction worker (8.21%), and other (16.81%); and ethnicity: Yugur (47.37%), Tibetan (24.56%), Han (26.07%), and Mongol and other ethnicity (2.01%).
Of the 12,000 participants, 7476 (62.30%) said they were aware of the need for early gastrointestinal cancer screening. Awareness about the need for screening based on participant characteristics is presented in Table 2. Awareness was significantly lower in men than in women (55.62% vs. 69.80%; P = 0.021). Awareness varied significantly by age (P < 0.001) and was lowest among those aged ≥65 years (30.94%) and highest among those aged 25 to 44 years (70.36%). Awareness varied significantly based on the level of education (P < 0.001) and was lowest among participants with an education level of primary school or less (38.65%) and highest among those with a college education or above (88.89%). Awareness differed significantly by area of residence (P < 0.001) and was lower among rural residents (52.60%) than in urban residents (77.68%). Awareness differed significantly according to occupation (P < 0.001) and was lowest among agricultural and animal husbandry workers (56.49%) and highest among those working in government agencies and institutions (84.25%). Awareness also differed significantly by ethnicity (P < 0.001) and was 62.49%, 58.64%, 65.89%, and 56.02% among respondents with Yugur, Tibetan, Han, and Mongol and other ethnicity, respectively.
Knowledge of early gastrointestinal cancer screening based on participant characteristics.
Discussion
Early gastrointestinal cancer is highly prevalent among high-risk individuals aged over 40 years, particularly those with chronic gastrointestinal diseases, a family history of gastrointestinal tumors, and Helicobacter pylori infection.2,10 If individuals with early gastrointestinal cancer do not receive timely treatment, the disease can progress and become invasive, with high morbidity and mortality. Owing to the absence of specific symptoms in the early stages of gastrointestinal cancer, diagnosis is often delayed, increasing the challenges to treatment and shortening patient survival. Therefore, reinforcing early screening for gastrointestinal cancer in clinical practice is imperative.11–13
In this study, we assessed the current level of awareness regarding the need for early gastrointestinal cancer screening in a county with a high proportion of people with Yugur ethnicity. The level of awareness about early gastrointestinal cancer screening among residents of the Yugur ethnic area was relatively low. Li P et al. 14 and Li H et al. 15 discovered significant differences in the level of awareness about cancer prevention and knowledge regarding treatment based on sex, age, and level of education in certain rural areas of China with upper gastrointestinal screening programs. Similarly, our study revealed significant differences in the level of awareness about early gastrointestinal cancer screening based on sex, age, education level, occupation, area of residence, and ethnicity. Relevant government departments should strengthen education and promote early gastrointestinal cancer screening in the study area to increase awareness about the need for early gastrointestinal cancer screening.
Compared with men, women in the Yugur ethnic area tended to be more concerned about health issues and had a higher level of understanding and knowledge related to early gastrointestinal cancer screening. Programs promoting early gastrointestinal cancer screening should target men and encourage them to develop healthy lifestyle behaviors. The level of awareness about early gastrointestinal cancer screening also decreased with increasing age. Therefore, education on early gastrointestinal cancer screening should also target older adults using materials in simple language. It is recommended that people aged over 40 years undergo early gastrointestinal cancer screening. Improving knowledge and awareness of gastrointestinal cancer and encouraging a healthy diet could reduce the occurrence of this disease.
In this survey, we identified a positive correlation between educational levels and the level of awareness about early gastrointestinal cancer screening. Targeting residents of our study who have low education levels and providing information in language that can be easily understood is crucial. Owing to the high level of education among employees of government agencies and public institutions, as well as the wide range of channels available for urban residents to access knowledge about early gastrointestinal cancer screening, the level of awareness about screening for this disease was high among these groups. Health education regarding gastrointestinal cancer screening should be provided to people working in other occupations and those living in rural areas. Sunan is vast and sparsely populated, with very few mobile personnel, most of whom are local residents. However, the Yugur ethnic group in Sunan, which is unique to Gansu Province, has strong grassroots organizational capabilities. These characteristics may have facilitated successful cooperation in completing the study questionnaire. This may also be one reason why such large-scale surveys are difficult to carry out in large cities with a large floating population.
Herein, we examined the cognitive status of early gastrointestinal cancer in the Yugur region of Gansu Province, China. To our knowledge, no such survey has been conducted to date in this region; thus, our cross-sectional study is novel in this regard. Further research, such as studies involving gastroscopy screening, should be conducted in the future.
Our study has some limitations. First, being a local survey, the study findings may not represent the overall situation. Second, although our survey volume accounted for a relatively high proportion of the total population in the Yugur region, the overall data volume remains relatively small. This study provides insight into the current status regarding knowledge and awareness levels in the Yugur region alone; larger sample sizes are needed to clarify the situation for all of Gansu Province and throughout China.
Comprehensive prevention and treatment of cancer have been implemented in some regions of China for many years. The country has established multiple support policies for early cancer screening projects in ethnic minority areas. Health and civil affairs departments are mandated to disseminate information on the dangers of early gastrointestinal cancer to residents of ethnic minority areas, raise awareness about the importance of comprehensive prevention and treatment of early gastrointestinal cancer, and strengthen comprehensive prevention and treatment of this disease by promoting knowledge about early gastrointestinal cancer, surveillance of early gastrointestinal cancer, monitoring the main risk factors of early gastrointestinal cancer, and conducting early diagnosis and treatment for the disease to reduce the incidence of early gastrointestinal cancer.16,17
Conclusion
We found that levels of awareness about early gastrointestinal cancer screening among residents of Sunan Yugur Autonomous County was relatively low and varied by age, education level, occupation, and area of residence. The government should prioritize promotion of knowledge about early gastrointestinal cancer screening in the study area to reduce the incidence and prevent progression of early gastrointestinal cancer, thereby improving the health status and quality of life among residents in the region.
Footnotes
Acknowledgement
Authors’ contributions
Caihong Wang contributed to the study conception, design, and execution and data acquisition, analysis, and interpretation. Yumei Niu participated in the study conceptualization and drafting reviewing, revising, and critical review of the article.
Data availability statement
The data generated in this study but not included in the tables of this article may be requested from the corresponding author.
Declaration of conflicting interest
The authors declare that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.