Screening programs for the early diagnosis of cancer are of critical importance for a better prognosis and long-term survival. It is recommended to start screening at the age of 40 in individuals with a first-degree relative (under 60 years of age) with colorectal cancer or adenoma . Furthermore, it is recommended to perform a fecal occult blood test (FOBT) and colorectaloscopy 10 years before the age of diagnosis of the family member diagnosed with colorectal cancer . In the literature, it is stated that individuals with a family history of colorectal cancer have insufficient information on screening and early diagnosis . In the study of Jenkins et al  on barriers to colorectal cancer screening, it was emphasized that individuals with a family history of colorectal cancer had a moderate level of knowledge. Similarly, in this study, undergoing chemotherapy with a diagnosis of colorectal cancer was found to have a moderate level of knowledge and awareness about colorectal cancers. In this study, it was also determined that individuals with a first-degree relative with colorectal cancer had a low level of awareness about the importance of early diagnosis and regular screenings.
In a study conducted by Freeman et al  with African American individuals, it was observed that education on early diagnosis of colorectal cancer increased the awareness of individuals and motivated them to participate in screening programs. Similarly, in a study by Denberg et al.  including the patients presenting to a primary care center in Colorado, it was reported that the education on colorectal cancers positively affected the awareness level of individuals and their participation in screening programs. In two studies [27,28] conducted on large sample groups in Europe, it was determined that the education on screening in colorectal cancers increased the awareness of individuals and their participation in screening programs. In the same studies, it was found that there was a relationship between the risk perceptions of colorectal cancers in individuals and motivation to develop protective behaviors [27,28].
The level of knowledge about colorectal cancers may vary according to the age, education level, and place of residence of the individual. In the cross-sectional study of Lynes et al.  aimed at determining the risk factors associated with colorectal cancers and awareness of the screening program, it was demonstrated that individuals under the age of 50 had less knowledge about both risk factors associated with lifestyle and the screening programs  Similarly, Jenkins et al.  reported that rural-dwelling individuals with a family history of colorectal cancer, with a low level of education and income, had a lower level of knowledge about colorectal cancer risk factors. The results of our study are in parallel with the literature. In this study, it was determined that low educated, elderly, and rural-dwelling individuals had a lower level of knowledge and awareness about early diagnosis, screenings, and risk factors in colorectal cancers.
Cancer awareness means knowing a certain type of cancer and the screening programs for early detection of this cancer. Individuals can get information about the disease through education, work, the experiences of the sick person or relatives in their family and friends, through television and social media, through information and screening programs implemented by non-governmental organizations and official institutions and organizations, and can raise awareness that the disease may also occur in them. In their study, Paramasivam et al.  mentioned that the level of awareness was a barrier to breast and colorectal cancer screenings, and they stated that individuals with no awareness of cancer did not participate in screening programs. In this study, 37.5% of the participants indicated that it was expensive to have regular check-ups for the early diagnosis of bowel cancer. It was found that 59.4% of the participants knew that regular check-ups for early diagnosis of bowel cancer would reduce the possibility of dying from bowel cancer. Regular health check-ups are recommended due to early diagnosis, treatment, follow-up of diseases, and similar situations. Furthermore, first-degree relatives of colorectal cancer patients need more education to increase their risk awareness levels.
In addition to familial predisposition, age, dietary habits, and sedentary lifestyle are also known to be effective in the occurrence of colorectal cancer. Early diagnosis is very important for treatment and survival in colorectal cancer, as in other types of cancer. In their study, Patel et al.  indicated that early diagnosis was very important in the prognosis of colorectal cancer. González et al.  reported that colorectal cancer cases were increasing rapidly and that early diagnosis was very important to prevent the rapid increase in cancer cases and mortality rates. Lewandowska et al.  emphasized that a sedentary lifestyle was an important risk factor for colorectal cancer. Our study is in parallel with the literature. In this study, it was found that only two-thirds of the participants knew that diabetes, obesity, sedentary lifestyle, smoking, and alcohol use increased the risk of colorectal cancer. It was found that only two-thirds of the participants knew that advanced age increased the risk of colorectal cancer. These results indicated that the majority of individuals with a family history of colorectal cancer needed information on early diagnosis and the risk factors such as advanced age and sedentary lifestyle.
Being acquainted with this disease due to the previous history of colorectal cancer in another relative may lead to the concern of "I wonder if it is my turn" inpatient relatives. In the study conducted by Şentürk et al. , it was reported that symptoms such as anxiety, depressive mood, and stress increased significantly in patients and their relatives during the cancer diagnosis process . In the study of Erdoğan et al.  it was determined that individuals caring for patients had concerns and doubts about the future, were not strong enough to fix some situations, and experienced feelings such as fear, anxiety, sadness, stress, depression, and insecurity, and that the stress they experienced through medical treatments increased the mortality rate of caregivers in 5 years . The results of this study are consistent with the literature. It was found that 64.5% of the participants knew that a family history of colon cancer increased the risk of colon cancer. This result indicated that individuals with a first-degree relative with a history of colorectal cancer should be informed about cancer risk factors.
The data obtained from the study provide information about the level of knowledge and awareness of 251 patient relatives about colorectal cancers. The presence of the COVID-19 pandemic at the time of the study led to difficulties in data collection.