When we think of cancer, we often think of breast cancer awareness campaigns with their pink ribbons and widespread educational efforts. But there’s another form of cancer that demands equal attention, particularly among women in underserved communities: colorectal cancer.
While it may seem like an uncomfortable subject — after all, screening involves collecting a stool sample — it is a conversation we must normalise. Especially for women, where cultural taboos, health care access issues, and stigma create barriers to life-saving screenings.
So, let’s talk about it. Let’s comfortably talk about colorectal health.
Colorectal cancer is the third most common cancer worldwide, and Malaysia is part of this catastrophic health reality. The disease accounts for 13.5 per cent of all cancer diagnoses, making it the second most common cancer in the country.
Here’s the catch, colorectal cancer is highly preventable if detected early. The preliminary screening for colorectal cancer uses the immunological Faecal Occult Blood Test (iFOBT), which detects blood in the stool
However, it is important to remember that a positive result doesn’t confirm cancer but signals the need for further investigation, like a colonoscopy to determine the cause, whether it’s polyps, haemorrhoids, inflammatory bowel disease, or cancer.
Yet, as my study shows, women in suburban communities in Malaysia, particularly among those of Indian descent, are mostly unaware of colorectal cancer, let alone the importance of screening for it.
This is a strong, evidence-based reflection of the health challenges and inequalities most women in our country face, as shown by previous studies. This knowledge disparity leads to dire consequences.
Most Malaysian colorectal cancer cases are only diagnosed in the late stages (Three and Four), when treatment efficacy is reduced and the survival rates drop dramatically. The urgency is clear: we must raise awareness and increase screening participation.
So, why are so few women getting screened?
My study, conducted among Malaysian Indian women in Bukit Katil, Melaka, reveals several factors at play. First, there’s a basic lack of knowledge about colorectal cancer and its screening methods.
While breast and cervical cancers receive significant attention, colorectal cancer remains comparatively under-discussed. Plus, the concept of screening by submitting a stool sample is also foreign, and let’s face it, yucky!
Beyond unfamiliarity, practical concerns also arise. The fear of receiving a positive diagnosis and the perceived financial burden of cancer treatment loom large. Some women in the study expressed anxiety about becoming a burden to their families if diagnosed, while others admitted to feeling too embarrassed or disgusted by the stool collection process.
This stigma is a powerful deterrent, deeply rooted in cultural attitudes toward discussing bodily functions and illnesses openly. Then there’s the fatalistic attitude some people hold. Even those aware of the test often question its necessity, especially if they are symptom-free and appear healthy.
Despite these barriers, the study also shines a light on potential solutions. In the face of fear and cultural taboos, one theme stood out: the power of community and family.
Women who participated in the focus groups revealed that family and friends’ encouragement played a significant role in their decision to undergo screening. Those with relatives urging them to complete the iFOBT test were more likely to follow through, even if they were initially hesitant.
This finding stresses a critical point: community and family support can overcome psychological barriers.
There’s also the undeniable influence of trusted institutions like the National Cancer Society Malaysia (NCSM). The outreach programmes NCSM conducted, which provided free iFOBT test kits and educational talks, were key in creating awareness and bridging the gap between knowledge and action. Interestingly, many women saw the health campaign as a sign — an intervention from God—motivating them to take the test.
By building on this spiritual influence, partnerships with religious institutions can be pivotal, as they hold a positive sway in many communities. By leveraging their trusted platforms, health messages can be delivered in a culturally sensitive manner, encouraging greater participation in screening programmes.
The stigma surrounding colorectal cancer screening, particularly the discomfort and embarrassment tied to the test itself, needs to be addressed through culturally appropriate health promotion.
This means adapting educational materials into local languages like Tamil and using platforms the women are already familiar with. As noted, many participants relied on social media platforms such as Facebook, TikTok, and WhatsApp for health information.
These channels present an untapped opportunity for delivering reliable health content and it’s time for organisations and health authorities to seize it.
But beyond merely providing information, we need to change the narrative around screening itself. The study found that breast cancer screenings are more familiar and accepted due to self-examination, while the at-home iFOBT test is not seen the same way.
So normalising the act of collecting a stool sample and framing it as an equally important self- exam could increase participation significantly.
The core of the study is a call for empowerment through education to enhance health agency and capabilities. Many of the women interviewed expressed that they simply didn’t know where to start.
But education alone isn’t enough; it needs to be combined with community action and a reorientation of healthcare services that put the patient, her fears, and her cultural context at the forefront.
This is where organisations like the NCSM have excelled, but more needs to be done to expand our reach. Empowering local women as peer educators could be a game-changer, allowing information to be disseminated within trusted social networks.
These women could serve as champions for health, demystifying the screening process and encouraging their community to overcome embarrassment and fear.
So, to address the initial question, “To poop or not to poop?” — the question might seem light-hearted, but the answer could be life-saving.
While participating in research and policy making are important steps, they are not sufficient on their own. To make a real impact, we need to go beyond raising awareness. We actually need to get people screened. It’s not just about sparking interest or checking off boxes with one-time educational programmes anymore.
Change requires a combination of community-led health education, capacity building, cultural thoughtfulness, and a health care system that responds to the unique needs of everyone, including those from rural and suburban areas.
This is where you come in. I challenge you to take action.
Start a conversation with your family and friends about colorectal cancer screening. Share the importance of early detection and cancer prevention. Encourage not just yourself but someone else to get screened. You have the power to influence those around you, to turn talk into action.
If we can tackle the stigma, break down barriers, and move this conversation from awareness to action, we can save lives — one test at a time.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
