Colorectal cancer is one of the most common cancers in Malaysia, yet it remains one of the least talked about.
Many people are uncomfortable discussing bowel habits, stool tests or colon health, and this silence has consequences.
Colorectal cancer usually develops slowly.
It often begins as small growths called polyps in the colon or rectum, which may not cause any symptoms for years.
During this early phase, people generally feel well and see no reason to seek medical attention.
By the time symptoms such as persistent abdominal pain, changes in bowel habits, unexplained weight loss or blood in the stool appear, the disease may already be advanced.
This is why screening matters.
Every year, thousands of Malaysians are diagnosed with colorectal cancer at a late stage, when treatment becomes more complex and survival rates decline.
What is often overlooked is that this cancer is largely preventable and detectable early through a simple screening test known as the immunochemical faecal occult blood test (iFOBT).
The Clinical Practice Guidelines for the Management of Colorectal Carcinoma recommend that Malaysian adults aged 50 to 75 years undergo regular colorectal cancer screening, even if they have no symptoms or known risk factors.
The iFOBT is designed to detect tiny amounts of blood in the stool that cannot be seen with the naked eye.
Such bleeding can be an early sign of colorectal cancer or precancerous polyps.
Unlike older stool tests, iFOBT is specific to human blood and does not require dietary restrictions.
It is simple, non-invasive and can be done at home.
For many people, it takes less than five minutes to collect a sample.
Why it's not done
Despite its simplicity, uptake of iFOBT screening in Malaysia remains low.
Some people believe that screening is only necessary when symptoms are present.
Others worry that the test will be unpleasant or embarrassing.
There is also fear of what the result might show, leading some to avoid testing altogether.
These concerns are understandable, but they can be addressed with better information and support.
One common misconception is that a stool test is unreliable.
In reality, iFOBT is a well-established screening tool used in many countries as the first step in colorectal cancer screening.
When done regularly, it has been shown to reduce deaths from colorectal cancer by detecting disease earlier.
A positive iFOBT result does not mean a person has cancer.
It simply indicates that further evaluation, usually a colonoscopy, is needed to find the source of bleeding.
Many times, the cause may be benign polyps or other non-cancerous conditions such as haemorrhoids.
Another barrier is the fear of follow-up procedures.
Colonoscopy, which is used to confirm a positive iFOBT result, is often viewed with anxiety.
While no medical test is entirely without discomfort, colonoscopy is a routine procedure performed safely every day.
More importantly, it allows doctors to remove precancerous polyps before they turn into cancer.
In this sense, colonoscopy is both a diagnostic and preventive procedure.
ALSO READ: Flush those colonoscopy fears
The iFOBT is relatively affordable – usually costing between RM20 and RM50 – and only needs to be done once a year.
Concerns often arise about what happens if the test is positive, as follow-up colonoscopy in the private sector can be costly.
Importantly, individuals with a positive iFOBT result can be referred to government hospitals, where colonoscopy and further care are provided at highly subsidised rates.
Pharmacies, a resource
Community pharmacies can play an important role in changing how Malaysians view colorectal cancer screening.
Pharmacies are familiar, accessible spaces where people already seek advice on medicines and health concerns.
Pharmacists are trained healthcare professionals who can explain how iFOBT works, address common fears and guide individuals on what to do next if a test result is positive.
Understanding one’s personal risk, knowing the benefits of early detection and having clear information about what screening involves empowers individuals to make decisions about their own health.
For adults aged 50 and above, especially those with no symptoms, iFOBT offers a practical way to take control of their colorectal health.
Talking openly about screening, normalising conversations about bowel health, and reducing fear around testing are essential to improve outcomes for colorectal cancer.
The message is straightforward.
If you are in the recommended age group, feel well and have no symptoms, do not wait.
Ask about colorectal cancer screening. Learn about iFOBT.
Taking a few minutes today could make a profound difference to your health tomorrow.
David Chang is a clinical research pharmacist and Yeow Shiau Hueh is a clinical pharmacist. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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