This study aimed to explore risk taking behaviors and determine potential factors affecting perceived susceptibility to colorectal cancer among the Malaysian population. Of the 305 respondents surveyed, 20.7% perceived high chances of having colorectal cancer. In the final model, age and race were significantly associated with perceived susceptibility to colorectal cancer.
To the best of our knowledge, this study was the first Malaysian study to assess self-reported risk-taking behaviour and perceived susceptibility to colorectal cancer. The estimated rate of perceived susceptibility reported in the present study was comparatively higher to that found in a British sample (17%)  but relatively lower than that reported from the United States of America (USA)(29-50%) [29–31].
Health behavioral theories predicted higher intentions of preventive actions among individuals with greater susceptibility to a disease [13, 32]. However, in the present study, self-reported susceptibility mirrored unsatisfactory preventive behaviours. The barriers to screening for colorectal cancer in this study were consistent with previous studies from Malaysia on the barriers of CRC screening  and USA [8, 34].
In the present study, perceived susceptibility to colorectal cancer was significantly higher among men. A previous study by Wardle et al., (2005)  found that men had low perceived susceptibility while some studies found no relationship between gender and perceived susceptibility [36–38]. Our study’s findings on the association between perceived susceptibility and age was consistent with previous studies [14, 39].
A new finding in this study was the significant association between perceived susceptibility and race. Despite the high incidence of colorectal cancer among ethnic Chinese in Malaysia , this study found higher perceived susceptibility among ethnic Malays and Indians in comparison to Chinese. A possible explanation could be due to a lack of information among respondents. In the literature, the association between ethnicity and perceived susceptibility was masked. A study by Shokar et al., (1990) concluded that whites were more likely to contract colorectal cancer than blacks.
This study found a significant relationship between perceived susceptibility and family history of colorectal cancer which was consistent with previous studies [13, 29, 31, 40].
This study also found a significant association between alcohol intake and the perceived susceptibility to colorectal cancer which was, again, consistent with a previous study . Our finding of the relationship between smoking and perceived susceptibility was inconsistent with some previous studies [15, 16]. Although some longitudinal studies had observed a positive relationship between perceived risk and subsequent behaviour, that association was weak and unsatisfactory. Some studies, however, find no association or even a negative one [32, 42].
The cross-sectional design of the current study can test the “accuracy hypothesis” that asserts that perceptions of risk at a certain time properly reflect one’s risk behaviours at that time . Thus, this design can be useful for identifying information deficits and the areas where further education is needed. The failure of the current study to find an association between the perceived susceptibility and risk taking behaviors could be attributed to the natural causal relationship between those variables in which the cross-sectional design was not appropriate . A second possible reason could be due to an inadequate specification of the links between perceived susceptibility and risk taking behaviour in the study questionnaire. In other words, our respondents may not answer the “perceived susceptibility” questions according to their awareness that smoking is a risk for developing cancer. To avoid such bias in the future, this study recommends phrasing the question in another way, for example, “If you don’t change your smoking behaviour, what is your chance of getting colorectal cancer in the future?” By using such a question, we can link the perceived susceptibility to the behaviour. An alternative way is to assess the relationship between the perceived susceptibility and the intention to quit or stop the risky behaviours. Although intentions may not necessarily predict or reflect the actual behaviours, it could be considered as an intermediate step towards action.
The cross-sectional nature of this study could not establish the causal relationships between perceived susceptibility and behaviour. Thus, further exploration is required through prospective and meta-analysis studies.