Keywords
Awareness, Cancer, Risk factors, Lebanese, Prevention
Abstract
Introduction: Since the majority of cancers occur as a result of modifiable risk factors, cancer is being seen more as a preventable disease. The primary objective of our study was to assess the level of awareness of environmental risk factors for cancer among the Lebanese general population. The secondary objective focused on identifying the predictors of the preventability of the disease.
Methods: We conducted a cross-sectional study between June and July 2020. An online questionnaire was used to collect data pertaining to the knowledge of environmental risk factors of cancer, source of information and personal practice of the participants. Bivariate and multivariate analyzes were performed.
Results: About 387 respondents agreed to participate in the study. study showed low awareness regarding infectious agents, lifestyle, diet and many work exposures. The predictors of the attitude of respondents regarding the preventability of cancer were: believing that cancer has an environmental cause (p=.014), not having a healthy lifestyle (p=.004), not smoking waterpipe (p=.023), being single (p=.013), and having a university degree (p=.049).
Conclusions: Efforts should be made to improve awareness of the cancer risk factors regarding infectious agents, lifestyle, diet and many work exposures. This can also be followed by further studies assessing the impact of these community and governmental cancer prevention initiatives on cancer risk factors level of awareness.
References
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[21] Ajrouche R, Roudier C, Cléro E, Ielsch G, Gay D, Guillevic J, Marant Micallef C, Vacquier B, Le Tertre A, Laurier D. Quantitative health impact of indoor radon in France. Radiat Environ Biophys 2018;57(3):205–14. doi:10.1007/s00411-018-0741-x.
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[23] Konieczna A, Rutkowska A, Rachoń D. Health risk of exposure to Bisphenol A (BPA). Rocz Panstw Zakl Hig 2015;66(1):5–11.
[24] Kokel D, Li Y, Qin J, Xue D. The nongenotoxic carcinogens naphthalene and para-dichlorobenzene suppress apoptosis in Caenorhabditis elegans. Nat Chem Biol 2006;2(6):338–45. doi:10.1038/nchembio791.
[25] Espina C, Straif K, Friis S, Kogevinas M, Saracci R, Vainio H, Schüz J. European Code against Cancer 4th Edition: Environment, occupation and cancer. Cancer Epidemiol 2015;39 Suppl 1:S84-92. doi:10.1016/j.canep.2015.03.017.
[26] Centers for disease control and precention. How to Prevent Cancer or Find It Early. Available at: https://www.cdc.gov/cancer/dcpc/prevention/index.htm. Accessed 17 July 2020
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[28] American institute for cancer research. 2019 AICR Cancer Risk Awareness Survey.; 2020. Available at: https://www.aicr.org/assets/can-prevent/docs/2019-Survey.pdf. Accessed 17 July 2020
[29] Connor K, Hudson B, Power E. Awareness of the Signs, Symptoms, and Risk Factors of Cancer and the Barriers to Seeking Help in the UK: Comparison of Survey Data Collected Online and Face-to-Face. JMIR Cancer 2020;6(1):e14539. doi:10.2196/14539.
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[32] Poudel K, Sumi N. Knowledge about Risk Factors for Cancer among Adults in Nepal. KnE Life Sci 2018;4(4):126. doi:10.18502/kls.v4i4.2270.
[33] Feizi A, Kazemnejad A, Babaee G, Parsayekta Z, Monjamed Z. Public Awareness of Risk Factors for Cancer and Its Determinants in an Iranian Population. Asia Pac J Public Health 2010;22(1):76–88. doi:10.1177/1010539509350768.
[34] Ahmed SBM, Amer S, Hussein A, Kampani DD, Al Hasham N, Assker MM, Shawa N, Saleh D, Alfarouk KO. Assessing the Knowledge of Environmental Risk Factors for Cancer among the UAE Population: A Pilot Study. Int J Environ Res Public Health 2020;17(9):2984. doi:10.3390/ijerph17092984.
[35] Al-Azri M, AL-Rasbi K, Al-Hinai M, Davidson R, Al-Maniri A. Awareness of Risk Factors for Cancer among Omani adults- A Community Based Study. Asian Pac J Cancer Prev 2014;15(13):5401–6. doi:10.7314/APJCP.2014.15.13.5401.
[36] Ravichandran K, Mohamed G, Al-Hamdan NA. Public knowledge on cancer and its determinants among Saudis in the Riyadh Region of Saudi Arabia. Asian Pac J Cancer Prev APJCP 2010;11(5):1175–80.
[37] Raj S, Piang LK, Nair KS, Tiwari VK, Kaur H, Singh B. Awareness Regarding Risk Factors, Symptoms and Treatment Facilities for Cancer in Selected States of India. Asian Pac J Cancer Prev 2012;13(8):4057–62. doi:10.7314/APJCP.2012.13.8.4057.
[38] Richards R, McNoe B, Iosua E, Reeder AI, Egan R, Marsh L, Robertson L, Maclennan B, Dawson A, Quigg R, Petersen A-C. Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015. Health Educ Res 2017. doi:10.1093/her/cyx036.
[39] Tfaily MA, Naamani D, Kassir A, Sleiman S, Ouattara M, Moacdieh MP, Jaffa MA. Awareness of Colorectal Cancer and Attitudes Towards Its Screening Guidelines in Lebanon. Ann Glob Health 2019;85(1):75. doi:10.5334/aogh.2437.
[40] El Asmar M, Bechnak A, Fares J, Al Oweini D, Al Razim A, El Achkar A, Tamim H. Knowledge, Attitudes and Practices Regarding Breast Cancer amongst Lebanese Females in Beirut. Asian Pac J Cancer Prev 2018;19(3). doi:10.22034/APJCP.2018.19.3.625.
[41] Shamseddine A, Saleh A, Charafeddine M, Seoud M, Mukherji D, Temraz S, Sibai AM. Cancer trends in Lebanon: a review of incidence rates for the period of 2003–2008 and projections until 2018. Popul Health Metr 2014;12(1):4. doi:10.1186/1478-7954-12-4.
[42] Shamseddine A, Sibai A-M, Gehchan N, Rahal B, El-Saghir N, Ghosn M, Aftimos G, Chamsuddine N, Seoud M. Cancer incidence in postwar Lebanon: findings from the first national population-based registry, 1998. Ann Epidemiol 2004;14(9):663–8. doi:10.1016/j.annepidem.2003.12.002.
[43] Ahmed HG. Survey on Knowledge and Attitudes Related to the Relation between Tobacco, Alcohol Abuse and Cancer in the Northern State of Sudan. Asian Pac J Cancer Prev 2013;14(4):2483–6. doi:10.7314/APJCP.2013.14.4.2483.
[44] Falzon C, Chalabaev A, Schuft L, Brizzi C, Ganga M, d’Arripe-Longueville F. Beliefs about Physical Activity in Sedentary Cancer Patients: an In-depth Interview Study in France. Asian Pac J Cancer Prev 2012;13(9):6033–8. doi:10.7314/APJCP.2012.13.12.6033.
[45] Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. The Lancet 2005;366 (9499):1784–93. doi:10.1016/S0140-6736(05)67725-2.
[46] Song M, Giovannucci E. Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States. JAMA Oncol 2016;2(9):1154. doi:10.1001/jamaoncol.2016.0843.
[47] Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, Irani J. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health 2011;11(1):244. doi:10.1186/1471-2458-11-244.
[48] El-Hajj M, Salameh P, Rachidi S, Al-Hajje A, Hosseini H. Cigarette and Waterpipe Smoking are Associated with the Risk of Stroke in Lebanon. J Epidemiol Glob Health 2019;9(1):62. doi:10.2991/jegh.k.181231.002.
[49] MOPH. Statistical Bulletin. Ministry of public health; 2020. Available at: https://www.moph.gov.lb/en/Pages/0/25192/statistical-bulletin. Accessed 17 July 2020
[2] Cancerindex. Lebanon Cancer Oranisations And Resources; 2020.Available at: http://www.cancerindex.org/Lebanon. Accessed July 17, 2020.
[3] Weiderpass E. Lifestyle and Cancer Risk. J Prev Med Pub Health. 2010;43(6):459. doi:10.3961/jpmph.2010.43.6.459
[4] Chen Y-C, Hunter DJ. Molecular Epidemiology of Cancer. CA Cancer J Clin. 2005;55(1):45-54. doi:10.3322/canjclin.55.1.45
[5] Aricò M, Schrappe M, Hunger SP, Carroll WL, Conter V, Galimberti S, Manabe A, Saha V, Baruchel A, Vettenranta K, Horibe K, Benoit Y, Pieters R, Escherich G, Silverman LB, Pui C-H, Valsecchi MG. Clinical Outcome of Children With Newly Diagnosed Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia Treated Between 1995 and 2005. J Clin Oncol 2010;28:4755–61. doi:10.1200/JCO.2010.30.1325.
[6] Monsalve J, Kapur J, Malkin D, Babyn PS. Imaging of Cancer Predisposition Syndromes in Children. RadioGraphics. 2011;31(1):263-80. doi:10.1148/rg.311105099
[7] Leon ME, Peruga A, McNeill A, Kralikova E, Guha N, Minozzi S, Espina C, Schüz J. European Code against Cancer, 4th Edition: Tobacco and cancer. Cancer Epidemiol 2015;39:S20–33. doi:10.1016/j.canep.2015.06.001.
[8] Thomas JL, Guo H, Carmella SG, Balbo S, Han S, Davis A, Yoder A, Murphy SE, An LC, Ahluwalia JS, Hecht SS. Metabolites of a Tobacco-Specific Lung Carcinogen in Children Exposed to Secondhand or Thirdhand Tobacco Smoke in Their Homes. Cancer Epidemiol Biomarkers Prev 2011;20(6):1213–21. doi:10.1158/1055-9965.EPI-10-1027.
[9] Cogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Freeman C, Galichet L, Wild CP. Preventable Exposures Associated With Human Cancers. JNCI J Natl Cancer Inst 2011;103(24):1827–39. doi:10.1093/jnci/djr483.
[10] Franceschi S, Bidoli E, Herrero R, Muñoz N. Comparison of cancers of the oral cavity and pharynx worldwide: etiological clues. Oral Oncol 2000;36(1):106–15. doi:10.1016/S1368-8375(99)00070-6.
[11] International Agency for Research on Cancer Personal Habits and Indoor Combustions. Available at: https://www.ncbi.nlm.nih.gov/books/NBK30439. Accessed December 1, 2020.
[12] Chang JS, Straif K, Guha N. The role of alcohol dehydrogenase genes in head and neck cancers: a systematic review and meta-analysis of ADH1B and ADH1C. Mutagenesis 2012;27(3):275–86. doi:10.1093/mutage/ger073.
[13] Lajous M. Folate, Vitamin B6, and Vitamin B12 Intake and the Risk of Breast Cancer Among Mexican Women. Cancer Epidemiol Biomarkers Prev 2006;15(3):443–8. doi:10.1158/1055-9965.EPI-05-0532.
[14] Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, Gansler T, Glynn T, Smith RA, Taubert K, Thun MJ, American Cancer Society, American Diabetes Association, American Heart Association. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Stroke 2004;35(8):1999–2010. doi:10.1161/01.CIR.0000133321.00456.00.
[15] Gil J, Stembalska A, Łaczmańska I, Sąsiadek M. Sporadic colorectal cancer – factors modulating individual susceptibility to cancer. Współczesna Onkol 2010;3:123–8. doi:10.5114/wo.2010.14132.
[16] Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health 2016;4(9):e609–16. doi:10.1016/S2214-109X(16)30143-7.
[17] De Flora S, LA MAESTRA S, CROCETTI E, MANGONE L, BIANCONI F, STRACCI F, BUZZONI C. Estimates of the incidence of infection-related cancers in Italy and Italian regions in 2018. J Prev Med Hyg 2019;60(4): E311-326 doi:10.15167/2421-4248/JPMH2019.60.4.1434.
[18] Center disease control. Occupational Cancer. Available at: https://www.cdc.gov/niosh/topics/cancer/default.html. Accessed on 17 July 2020
[19] International Agency for Research on Cancer. IARC Monographs on the Identification of Carcinogenic Hazards to Humans; 2020.Available at: https: //monographs.iarc.fr/agents-classified-by-the-iarc. Accessed 17 July 2020
[20] Cherrie JW, Hutchings S, Gorman Ng M, Mistry R, Corden C, Lamb J, Sánchez Jiménez A, Shafrir A, Sobey M, van Tongeren M, Rushton L. Prioritising action on occupational carcinogens in Europe: a socioeconomic and health impact assessment. Br J Cancer 2017;117(2):274–81. doi:10.1038/bjc.2017.161.
[21] Ajrouche R, Roudier C, Cléro E, Ielsch G, Gay D, Guillevic J, Marant Micallef C, Vacquier B, Le Tertre A, Laurier D. Quantitative health impact of indoor radon in France. Radiat Environ Biophys 2018;57(3):205–14. doi:10.1007/s00411-018-0741-x.
[22] Maggiore G, De Filippis G, Totaro T, Tamborino B, Idolo A, Serio F, Castorini IF, Valenzano B, Riccio A, Miani A, Caricato AP, Martino M, De Donno A, Piscitelli P. Evaluation of Radon Exposure Risk and Lung Cancer Incidence/Mortality in South-Eastern Italy. J Prev Med Hyg 2020; 61(1): E31-38. doi:10.15167/2421-4248/JPMH2020.61.1.1343.
[23] Konieczna A, Rutkowska A, Rachoń D. Health risk of exposure to Bisphenol A (BPA). Rocz Panstw Zakl Hig 2015;66(1):5–11.
[24] Kokel D, Li Y, Qin J, Xue D. The nongenotoxic carcinogens naphthalene and para-dichlorobenzene suppress apoptosis in Caenorhabditis elegans. Nat Chem Biol 2006;2(6):338–45. doi:10.1038/nchembio791.
[25] Espina C, Straif K, Friis S, Kogevinas M, Saracci R, Vainio H, Schüz J. European Code against Cancer 4th Edition: Environment, occupation and cancer. Cancer Epidemiol 2015;39 Suppl 1:S84-92. doi:10.1016/j.canep.2015.03.017.
[26] Centers for disease control and precention. How to Prevent Cancer or Find It Early. Available at: https://www.cdc.gov/cancer/dcpc/prevention/index.htm. Accessed 17 July 2020
[27] Valle I, Tramalloni D, Bragazzi NL. Cancer prevention: state of the art and future prospects. J Prev Med Hyg 2015;56(1):E21-27.
[28] American institute for cancer research. 2019 AICR Cancer Risk Awareness Survey.; 2020. Available at: https://www.aicr.org/assets/can-prevent/docs/2019-Survey.pdf. Accessed 17 July 2020
[29] Connor K, Hudson B, Power E. Awareness of the Signs, Symptoms, and Risk Factors of Cancer and the Barriers to Seeking Help in the UK: Comparison of Survey Data Collected Online and Face-to-Face. JMIR Cancer 2020;6(1):e14539. doi:10.2196/14539.
[30] Inoue M, Iwasaki M, Otani T, Sasazuki S, Tsugane S. Public awareness of risk factors for cancer among the Japanese general population: A population-based survey. BMC Public Health 2006;6(1):2. doi:10.1186/1471-2458-6-2.
[31] Munishi OM, McCormack V, Mchome B, Mangi G, Zullig LL, Bartlett J, Mapunda O, Nyindo P, Namwai T, Muiruri C, Kimaro F, Karia F, Mmbaga BT. Awareness of Cancer Risk Factors and Its Signs and Symptoms in Northern Tanzania: a Cross-Sectional Survey in the General Population and in People Living with HIV. J Cancer Educ Off J Am Assoc Cancer Educ 2020;35(4):696–704. doi:10.1007/s13187-019-01513-6.
[32] Poudel K, Sumi N. Knowledge about Risk Factors for Cancer among Adults in Nepal. KnE Life Sci 2018;4(4):126. doi:10.18502/kls.v4i4.2270.
[33] Feizi A, Kazemnejad A, Babaee G, Parsayekta Z, Monjamed Z. Public Awareness of Risk Factors for Cancer and Its Determinants in an Iranian Population. Asia Pac J Public Health 2010;22(1):76–88. doi:10.1177/1010539509350768.
[34] Ahmed SBM, Amer S, Hussein A, Kampani DD, Al Hasham N, Assker MM, Shawa N, Saleh D, Alfarouk KO. Assessing the Knowledge of Environmental Risk Factors for Cancer among the UAE Population: A Pilot Study. Int J Environ Res Public Health 2020;17(9):2984. doi:10.3390/ijerph17092984.
[35] Al-Azri M, AL-Rasbi K, Al-Hinai M, Davidson R, Al-Maniri A. Awareness of Risk Factors for Cancer among Omani adults- A Community Based Study. Asian Pac J Cancer Prev 2014;15(13):5401–6. doi:10.7314/APJCP.2014.15.13.5401.
[36] Ravichandran K, Mohamed G, Al-Hamdan NA. Public knowledge on cancer and its determinants among Saudis in the Riyadh Region of Saudi Arabia. Asian Pac J Cancer Prev APJCP 2010;11(5):1175–80.
[37] Raj S, Piang LK, Nair KS, Tiwari VK, Kaur H, Singh B. Awareness Regarding Risk Factors, Symptoms and Treatment Facilities for Cancer in Selected States of India. Asian Pac J Cancer Prev 2012;13(8):4057–62. doi:10.7314/APJCP.2012.13.8.4057.
[38] Richards R, McNoe B, Iosua E, Reeder AI, Egan R, Marsh L, Robertson L, Maclennan B, Dawson A, Quigg R, Petersen A-C. Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015. Health Educ Res 2017. doi:10.1093/her/cyx036.
[39] Tfaily MA, Naamani D, Kassir A, Sleiman S, Ouattara M, Moacdieh MP, Jaffa MA. Awareness of Colorectal Cancer and Attitudes Towards Its Screening Guidelines in Lebanon. Ann Glob Health 2019;85(1):75. doi:10.5334/aogh.2437.
[40] El Asmar M, Bechnak A, Fares J, Al Oweini D, Al Razim A, El Achkar A, Tamim H. Knowledge, Attitudes and Practices Regarding Breast Cancer amongst Lebanese Females in Beirut. Asian Pac J Cancer Prev 2018;19(3). doi:10.22034/APJCP.2018.19.3.625.
[41] Shamseddine A, Saleh A, Charafeddine M, Seoud M, Mukherji D, Temraz S, Sibai AM. Cancer trends in Lebanon: a review of incidence rates for the period of 2003–2008 and projections until 2018. Popul Health Metr 2014;12(1):4. doi:10.1186/1478-7954-12-4.
[42] Shamseddine A, Sibai A-M, Gehchan N, Rahal B, El-Saghir N, Ghosn M, Aftimos G, Chamsuddine N, Seoud M. Cancer incidence in postwar Lebanon: findings from the first national population-based registry, 1998. Ann Epidemiol 2004;14(9):663–8. doi:10.1016/j.annepidem.2003.12.002.
[43] Ahmed HG. Survey on Knowledge and Attitudes Related to the Relation between Tobacco, Alcohol Abuse and Cancer in the Northern State of Sudan. Asian Pac J Cancer Prev 2013;14(4):2483–6. doi:10.7314/APJCP.2013.14.4.2483.
[44] Falzon C, Chalabaev A, Schuft L, Brizzi C, Ganga M, d’Arripe-Longueville F. Beliefs about Physical Activity in Sedentary Cancer Patients: an In-depth Interview Study in France. Asian Pac J Cancer Prev 2012;13(9):6033–8. doi:10.7314/APJCP.2012.13.12.6033.
[45] Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. The Lancet 2005;366 (9499):1784–93. doi:10.1016/S0140-6736(05)67725-2.
[46] Song M, Giovannucci E. Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States. JAMA Oncol 2016;2(9):1154. doi:10.1001/jamaoncol.2016.0843.
[47] Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, Irani J. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health 2011;11(1):244. doi:10.1186/1471-2458-11-244.
[48] El-Hajj M, Salameh P, Rachidi S, Al-Hajje A, Hosseini H. Cigarette and Waterpipe Smoking are Associated with the Risk of Stroke in Lebanon. J Epidemiol Glob Health 2019;9(1):62. doi:10.2991/jegh.k.181231.002.
[49] MOPH. Statistical Bulletin. Ministry of public health; 2020. Available at: https://www.moph.gov.lb/en/Pages/0/25192/statistical-bulletin. Accessed 17 July 2020