Colorectal cancer in Sydney South West Area Health Service

Colorectal cancer (CRC) is a major health problem. It is the second leading cause of cancer and cancer-related death in Australia. The effect of demography, specifically birthplace on the clinical presentations, screening and treatment utilisation, and pathological characteristics of CRC in an ethnically diverse community is not well described. Participation in CRC screening tests, knowledge and awareness of CRC and available tests may also be influenced by patients birthplace. In addition, medical practitioners screening practices are largely unknown, and whether these practices differ according to their or their patients birthplace, thereby affecting the likelihood of patients receiving screening recommendations need immediate evaluation.Research conducted in this thesis revealed few immigrants, especially those from Asia and Middle-East, had CRC detected through screening. After correcting for birthplace and demography, the poorer screening participation was primarily attributed to the absence of a medical practitioner recommendation, and to a lesser extent decreased media exposure and poorer perception of CRC. Knowledge, attitudes and barriers towards CRC and screening tests were also significantly poorer among immigrants. Medical practitioners CRC screening practices varied according to their ethnicity and that of their patients, resulting in lower screening recommendations to immigrant patients. These studies identified disparities based on demography, and provided specific directions to improve the participation of screening tests and outcomes from CRC. Additionally, compared with Australia, countries in the Asia-Pacific region reported significant variations in the CRC screening participation, knowledge, attitudes and barriers towards CRC. Deficiencies in participation of screening tests were evident even among countries with existing population screening programs. Medical practitioner recommendation was again the most important predictor of screening participation in all participating countries. Finally, younger women had improved survival from CRC compared with men, suggesting that oestrogen improved CRC-related survival and supporting the importance of oestrogen in the pathogenesis of CRC