The rising trend of Colorectal Cancer (CRC) incidence has become a global concern. Spatial determinants may play an important role as suggested by registered geographical variations of CRC incidence. The current study was designed to identify the spatial distribution pattern of CRC at the neighbourhood level in Malaysia by geocoding the addresses of CRC cases registered by the National Cancer Registry between 2010 and 2016. Cluster analysis was performed to examine the spatial dependence of CRC cases as well as group differences with regard to socio demographic characteristics. Identified clusters were categorized into urban and rural areas based on the population background. Most of the 18,405 individuals included in the study were male (56%) and people aged between 60 and 69 years (30.3%). Among patients with available information on their CRC stage, 71.3% presented for care late (at stages III or IV of the disease). The Malaysian states shown to have CRC clusters were Kedah, Penang, Perak, Selangor, Kuala Lumpur, Melaka, Johor, Kelantan and Sarawak. Spatial autocorrelation detected significant clustering (Moran’s I = 0.244, p < 0.01, Z-score >2.58). The CRC clusters in Penang, Selangor, Kuala Lumpur, Melaka, Johor and Sarawak occurred in urbanized areas, while those in Kedah, Perak and Kelantan were in rural areas. Factors associated with urban CRC clusters as shown by Odds Ratio (OR) included late-stage presentation (1.27, CI 1.15-1.41); post-mortem diagnosis (0.82, CI 0.76-0.89); and adenocarcinoma type of the cancer (0.81, CI 0.67- 0.98). We conclude that the presence of several clusters in urban ized and rural areas implies the impact of ecological determinants at the neighbourhood level. These findings can be used to guide the policymakers in resource allocation and cancer control.

Introduction : Colorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program. Methods: This study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in sup porting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program. Discussion: Through this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.