Cancer awareness and self-examination practices in young men and women

Knowledge of cancer symptoms and risk factors: A cross-sectional study from a developing country

The delayed presentation of cancer patients to healthcare facilities for diagnosis is a pressing issue, as late-stage cancer cases are often more challenging to treat effectively. In low-resource settings, such as those with limited access to healthcare facilities, the impact of inadequate awareness of cancer signs and symptoms can be particularly severe. Therefore, this study aimed to evaluate public knowledge of cancer signs and symptoms and risk factors in the context of Jordan. This cross-sectional study was conducted among participants from all settings. Data was obtained from an Arabic version of the cancer awareness measure (CAM), which was answered online. It described demographic data and knowledge of cancer prevalence, age-related risk, signs, symptoms, and risk factors in recall and recognition-type questions. Participants (n = 1998) completed the questionnaire with a Median age of 35 and an interquartile range of 24. About half (n = 1070) thought that cancer is unrelated to age. Most participants identified breast cancer as the most common cancer among women (81%). Awareness of cancer signs/symptoms significantly differed in the level of knowledge in favor of females. The symptom "unexplained weight loss" was most commonly recognized (66.3%) and "persistent difficulty swallowing" the least (42.6%). As for risk factors, "smoking" was the most identified (76.9%) and "eating less than 5 portions of fruits and vegetables a day" was the least (19%), and "doing <30 minutes of moderate physical activity 5 times a week" as a close second least (19.95%). Females identified "smoking," "passive smoking," "HPV infection," and "having a close relative with cancer" as risk factors significantly more than males. Those with good economic status were more aware that smoking is a cancer risk factor by 1.51 times compared to those with poor economic status. To enhance early diagnosis and presentation in Jordan, there is a need for increased public awareness of the signs, symptoms, and risk factors of cancer. One effective strategy to achieve this goal is to conduct targeted public campaigns that cater to different population groups, such as the youth, to improve their understanding and ensure that the message resonates.

The Association Between Testicular Self-Examination and Stages of Testicular Cancer Diagnosis: A Cross-Sectional Analysis

Purpose: Testicular cancer (TC) is the most prevalent tumor diagnosed in men 15-40 years of age. Survivorship and quality of life dramatically decrease with late-stage diagnosis. Testicular self-examination (TSE) is a diagnostic method used to discover early-stage tumor incidence. This study examines the relationship between practicing TSE and stage of diagnosis for TC survivors. Methods: A cross-sectional study design was employed, a 40-item survey among TC survivors (n = 619). Bivariate analyses consisted of Spearman Rho correlations of all primary variables with stage diagnosis of TC. Multivariate analysis employed an ordered logistic regression to determine stage diagnosis predictors. Results: "Regular" TSE practice significantly related with awareness (r = 0.4533) and knowledge of (r = 0.4866) TSE, confidence performing TSE (r = 0.4961), and feeling shape/feel differences of the testicle before diagnosis (r = 0.2115). Factors that had a statistically significant negative association with later-stage diagnosis included awareness (r = -0.1180) and knowledge of (r = -0.1586) TSE, confidence performing TSE (r = -0.1138), and feeling shape/feel differences of the testicle before diagnosis (r = -0.2938), among others. Regular TSE practice significantly predicted decreased odds of later-stage diagnosis within the sample subset reporting delay (odds ratio = 0.1628; p < 0.05); however, there was no significant relationship between regular TSE practice and stage diagnosis within the other model variations. Conclusion: This exploratory analysis aimed to provide baseline evidence of the possible association between the practice of TSE and the stage of TC diagnosis, and therefore making an indirect claim that TSE has the potential to improve quality of life and decrease TC mortality, particularly among adolescents and young adults.

Lung Cancer Risk Perception Among Older Smokers; a Cross-sectional Study

Background: Lung cancer is one of the deadliest cancers around the world. Also, scientific evidence proves the considerably lower lung cancer risk perceptions of smokers compared to non-smokers. Objectives: This study aimed at assessing the risk perception of smokers about their risk to contract lung cancer and their perceptions about lung cancer survival. Methods: In this cross-sectional study, the data were collected from 215 smokers in Tabriz, Iran, between April 2019 and July 2019. The data collection tool was designed, using validated questionnaires and contained questions on the perceived risk of smokers to develop lung cancer and their perception of lung cancer survival. A general linear model was conducted to model the relationship of risk perception with underlying predictors considering a significance level of 0.1. Results: The results of modeling indicated that perceived susceptibility (P-Sus) was negatively related to “years smoked” in simple regression (B = -0.035, P = 0.069) and multiple regression (B = -0.069, P = 0.007). P-Sus was also negatively related to the variable “age” in the age category of 45 to 50 years (B = -1.981, P = 0.046). Moreover, perceived severity (P-Sev) was negatively related to the variable “sex” (B = -1.037, P = 0.068). The results of the Spearman correlation indicated significant and direct correlations between “quitting intention” and P-Sus (r = 0.296, P < 0.001), P-Sev (r = 0.162, P = 0.009). Conclusions: Lung cancer risk perception of participants was moderately above the average and significant correlations were observed between “quitting intention” and “P-Sus” and “P-Sev” and “Risk Perception score”. This could be utilized in developing educational programs to promote awareness about lung cancer, especially for smokers.

Cancer Knowledge Among Mexican Immigrant Farmworkers in North Carolina

Latino farmworkers are exposed to a number of carcinogens in the workplace. Cancer survival rates for Latinos are below average. This paper describes Mexican immigrant farmworkers' knowledge of colorectal, breast, and testicular cancer, and compares farmworkers' cancer knowledge to that of other Mexican immigrants. Survey interviews for this study were conducted with 100 farmworkers and 100 non-farmworkers in 2015 in North Carolina as part of an ongoing community-based participatory research project. We found low to moderate levels of knowledge about colorectal, breast, and testicular cancer among farmworkers. Compared to non-farmworkers, farmworkers had similar levels of knowledge about breast and testicular cancer, but slightly lower knowledge about colorectal cancer (p = 0.0087). Few studies have used quantitative methods to assess farmworkers' knowledge of specific types of cancer. Our results demonstrate a need for increased dissemination of existing cancer education programs and further research to develop additional educational tools.

Can Smartphones Promote Cancer Prevention Behaviours in Healthy Young Adults? A Prospective Study

Cancer prevention should start as early as possible. Young adults would benefit largely from the use of a smartphone app aiming at promoting cancer prevention behaviours. The aims of the study described in this paper are to (1) examine the user participation and engagement with a cancer prevention app in real-life settings and (2) assess changes in the users' cancer prevention behaviours. A cancer prevention smartphone app called Happy was developed and released to the general population. Data from registered app users' (N = 3326) demographics and baseline cancer prevention behaviours was analysed. App engagement was measured and all behaviour data logged through the app was analysed to assess the effectiveness of the app in the promotion of cancer prevention behaviours. User demographics and baseline behaviour assessment show that the app reached its intended target population: young adults that generally do not comply with cancer prevention guidelines. Logged behavioural data showed an increased frequency in several cancer prevention behaviours and a significant increase in the overall putative cancer prevention level (p < 0.001). However, user engagement with the app was limited and might condition the long-term impact of such changes. Happy reached its intended population and seems to be an effective tool to promote cancer prevention. Further research is needed to fully assess its long-term persuasive potential.

Balanitis xerotica obliterans: a review of diagnosis and management

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).^3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.⁴¹ There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.

Developing the "Control Identity" Typology to Create More Effective Testicular Health Promotional Messaging

Testicular self-examination (TSE) promotional interventions historically operate without a theoretical framework, which negatively influences their effectiveness. As TSE is critical to the early detection of testicular cancer, this behavior is an essential component to improving overall male well-being. To address this need, the Control Identity personality typology was developed to assist in creating more effective TSE promotional interventions. Four outcome control dispositions were defined a priori based on the dimensions of illusions of control and locus of control. An original 41-item survey, the Control Identity Assessment Scale, was used to assess perceived vulnerability, value of health promotion, and health outcome control among a convenience sample of 300 university males aged 18 to 35 years via a cross-sectional research design. Factor and cluster analyses were employed to extract salient factors in the data and to identify subgroups within the sample. A consistent five-factor structure matrix (~70% explained variance) served as the foundation from which a k-means cluster analysis was employed to classify four types of individuals. Significant differences were detected between clusters on primary variables, including behavioral intentions to conduct TSE. The Control Identity typology aims to provide the needed mechanism for health practitioners to create more effective preventive health messaging to promote TSE. Future implications on employing this typology to segment audiences in order to increase overall effectiveness are offered. Application of this typology could ultimately lead to increasing TSE knowledge retention, behavioral intentions, actual performance, and adherence.

Awareness of Cancer Symptoms and Barriers to Seeking Medical Help Among Adult People Attending Primary Care Settings in Oman

Objectives:

To explore the public’s awareness of cancer symptoms and the barriers to seeking medical help among Omani adults attending primary care settings in Muscat governorate, the capital city of Oman.

Methods:

The Cancer Awareness Measure (CAM) questionnaire (translated into Arabic) was used to collect data from a total of 12 randomly selected local health centers (LHCs) in Muscat governorate, the capital city of Oman. Omani adults aged 18 years and above attending LHCs during the study period were invited to participate in the study. Statistical Package for the Social Sciences (SPSS version 22) was used to analyze the data.

Results:

A total of 999 participants completed the CAM questionnaire from 1200 invitations (response rate = 83%). The overall recognition of common cancer symptoms was less than 50% except for an unexplained lump/swelling, which was 71%. Multinomial logistic regression showed that women recognized more cancer symptoms than men (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.27-2.51), that more highly educated participations recognized more cancer symptoms than less educated participants (OR = 39; 95% CI: 0.23-0.69). The majority of participants (91.2%) agreed that the right time to seek medical help for possible cancer symptom was within 2 weeks. Multinomial logistic regression showed that women rather than men were more likely to perceive barriers to seeking medical help (OR = 2.10; 95% CI: 1.60-2.76). Also the less educated participants, rather than more educated, were more likely to perceive barriers to seeking medical help (OR = 2.17; 95% CI: 1.16-4.05).

Conclusion:

Levels of awareness of cancer symptoms are low in Oman. More national CAMs are needed in Oman to increase public knowledge of cancer symptoms. Also, more public awareness is needed to overcome the barriers to seeking timely medical help particularly among groups of women and the unmarried, widowed, divorced, or separated if delays in presentation are to be minimized.

Gender and Ethnic Differences in Health Beliefs and Behaviors

This study explored the extent to which college men and women of various racial and ethnic groups differ in their health beliefs and behaviors. Exploratory factor analyses of survey responses from a diverse sample of 1816 undergraduate students identified 21 items in six cohesive domains: Diet; Anger and Stress; Preventive Care; Medical Compliance; Substance Use; and Beliefs about Masculinity. Analyses of variance explored group differences across these domains. Findings revealed consistent gender differences, with men engaging in riskier behaviors and holding riskier beliefs than women. Main effects for ethnicity were also observed, but only for the diet domain was a gender by ethnicity interaction found. Implications for establishing gender- and ethnicity-based health promotion and disease prevention interventions are discussed.

Testicular self-examination amongst genitourinary medicine clinic attendees

Advancements in the diagnosis and treatment of testicular cancer now give a five-year survival rate of 97.2%. Delayed presentation remains the primary cause of poor outcome and recommendations have stressed that men, particularly those with risk factors, should undertake regular testicular self-examination. This study aimed to determine testicular self-examination knowledge and practices amongst 740 unselected men attending a genitourinary medicine clinic via questionnaire survey. Of respondents, 75.8% of men had heard of testicular cancer, and 79.9% had heard of testicular self-examination. Of these, 41% of men had been taught testicular self-examination; 73.9% of them by a doctor or nurse. Importantly, 79.2% had previously performed testicular self-examination. The most common reason for not performing testicular self-examination was 'Don't really know what to look for' (59.5%). Men previously taught testicular self-examination were 11.5 times more likely to perform the practice than those untaught. Of respondents, 74.1% wanted more information regarding testicular self-examination whilst attending the clinic. This study shows an increased level of testicular self-examination amongst genitourinary medicine attendees than has been previously demonstrated in other patient groups. There remains room for improvement via further health promotion and research on the effectiveness of testicular self-examination.

Integrating men's health and masculinity theories to explain colorectal cancer screening behavior

Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors.

Educating young men about testicular cancer: support for a comprehensive testicular cancer campaign

Despite the prevalence of testicular cancer among men 15-39 years of age, little has been done to increase awareness of this disease or educate males about its prevention. To fill this gap, the Standard Model of Health Communication was incorporated to design and implement a comprehensive testicular cancer campaign among male college students. To test the effectiveness of these messages, college students (N = 220) completed measures before and after the campaign. In addition, the authors obtained a control group of male college students (N = 52) who were not exposed to the messages. Survey items assessed awareness of testicular cancer and behaviors related to testicular cancer. Participants' knowledge of testicular cancer and likelihood of conducting a testicular self-exam increased significantly after being exposed to the campaign information. Men who were exposed to testicular cancer messages were more knowledgeable about testicular cancer and were more likely to conduct testicular self-examinations than were men in the control group.

Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N = 303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.

Attitudes to cancer and cancer prevention: what do people aged 35-54 years think?

The aim of this study was to explore the knowledge, attitudes and behaviours of people in mid-life towards cancer prevention. The study was undertaken in Northern Ireland between 2003 and 2007. This was a mixed methods study using a sequential exploratory design. The theoretical framework was the Theory of Planned Behaviour and the methodology was based on Sutton's framework. There were three methodological stages in the study using focus groups, a large cross-sectional survey and a volunteer sample survey. This paper focuses on the findings of the cross-sectional survey relating to the attitudes of people in mid-life towards cancer and cancer prevention. Findings are considered in relation to the respondents' level of knowledge, age, gender, level of educational attainment and socio-economic status. Evidence from this study shows that attitudes towards cancer and cancer prevention are associated significantly with level of knowledge about cancer, gender, socio-economic status and level of educational attainment. In conclusion, the evidence from this study shows that men, those with a lower level of education, those with a lower level of knowledge and those in a lower socio-economic group were more likely to hold negative attitudes about cancer and cancer prevention.

An exploration of public knowledge of warning signs for cancer

BACKGROUND

Warning signs of cancer have long been used as an effective way to summarise and communicate early indications of cancer to the public. Given the increasing global burden of cancer, the communication of these warning signs to the public is more important than ever before.

AIM

This paper presents part of a larger study which explored the attitudes, knowledge and behaviours of people in mid-life towards cancer prevention. The focus of this paper is on the assessment of the knowledge of members of the public aged between 35 and 54 years of age.

METHOD

A questionnaire was administered to a representative sample of the population listing 17 warning signs of cancer. These included the correct warning signs and distracter signs. Respondents were asked to correctly identify the seven warning signs.

RESULTS

Findings show that respondents could identify 4.8 cancer warning signs correctly. Analysis by demographics shows that being female, being older, having a higher level of educational attainment and being in a higher socio-economic group are predictors of better level of knowledge of cancer warning signs.

RECOMMENDATIONS

Recommendations are proffered with regard to better targeting, clarification and communication of cancer warning signs.

Public awareness of testis cancer and the prevalence of testicular self-examination-changing patterns over 20 years

OBJECTIVES

Delay in treatment of testis cancer (TC) has a proven negative impact on disease stage, treatment outcome, and mortality. Poor public awareness of the disease and lack of testis self-examination (TSE) may account for late presentation. The aim of this study was to examine the knowledge of TC and performance of TSE in a group of men over 2 time periods 20 years apart.

METHODS

In the current study, 677 men from a banking institution were surveyed on their knowledge of TC and their performance of TSE. Comparisons were made from the current data and those from the original study in 1986.

RESULTS

This study demonstrates an increase in public awareness and modest concomitant increase in TSE since first studied in this country in 1986. There was no difference in knowledge across age groups in this study. Furthermore, men who demonstrate a superior degree of knowledge were more likely to perform TSE. Limitations included possible selection bias in the 2 studies conducted in a banking institution.

CONCLUSIONS

Increased testicular cancer knowledge combined with TSE may have a role in improving detection of significant testicular pathology.

Scrotal signs and symptoms in the general population, the value of testis self-examination and the pitfalls of a scrotal screening programme: is the two-week rule relevant?

PURPOSE

Testicular symptoms/lumps are a cause of concern, anxiety and possible diagnostic dilemma for patient and general practitioner. The majority of scrotal pathology is benign in nature and results in a huge workload. The main aim of this study was to determine the relationship between scrotal symptoms, previous scrotal surgery, testicular self-examination and awareness of scrotal abnormalities. Secondarily, we sought to determine the scrotal findings in men enrolled in a consultant urologist-directed screening programme.

METHODS

There were 677 men surveyed on their performance of TSE. They were also asked about scrotal symptoms and prior surgery, before undergoing blinded physical examination by one of four consultant urologists.

RESULTS

Among the participants, 9.8% of men had scrotal symptoms with 55% of these having a normal scrotal examination and the rest having benign pathology. A number of men who had undergone previous scrotal surgery (13%) had no clinical findings detected on scrotal examination. No subject was found to have testis cancer; 20.9% had a benign scrotal or inguinal condition detected with the majority (65%) not aware of the abnormality. Men who demonstrate a superior awareness of their scrotal abnormalities were more likely to perform TSE.

CONCLUSIONS

Increased awareness of scrotal abnormalities combined with TSE may have a role in improving detection of significant testicular pathology. However, the high prevalence of benign scrotal conditions, of which most men were unaware, may serve to raise anxiety in the patient and general practitioner. We believe there is no role for a one-stop scrotal anxiety clinic, as the costs do not justify the benefits.

Public Awareness of Risk Factors for Cancer and Its Determinants in an Iranian Population

Cancer is increasingly being seen as a disease that is preventable and manageable. Knowledge often does constitute one element in the behavior change process. In addition, to promote the cancer prevention programs, data on level of knowledge among the target population are needed. The present research (as the first) aimed at providing information on level and correlates of awareness of cancer risk factors among the general public in Iran. The level of knowledge about 12 cancer risk factors (as a section of a multipart questionnaire) was assessed in a representative sample of 2500 adults (aged >18 years) in Tehran, Iran. The data were analyzed using latent class regression with the R statistical package. A small proportion of the respondents (12.2%) had high knowledge level and most of them had mixed (56.9%) and low level of awareness (30.9%). The most important determinants of knowledge level included level of education, gender, and family history. The results provided valuable clues and guidelines toward the formulation of relevant cancer prevention strategies, especially within the scope of health education. The applied statistical model presented a new descriptive and analytical perspective to evaluate the level of knowledge about the cancer risk factors and its determinants.

Factors associated with testicular self-examination among unaffected men from multiple-case testicular cancer families

Background

The lifetime testicular cancer (TC) risk in the general population is relatively low (~1 in 250), but men with a family history of TC are at 4 to 9 times greater risk than those without. Some health and professional organizations recommend consideration of testicular self-examination (TSE) for certain high-risk groups (e.g. men with a family history of TC). Yet little is known about factors associated with TSE behaviors in this at-risk group.

Methods

We collected information on this subject during an on-going NCI multidisciplinary, etiologically-focused, cross-sectional Familial Testicular Cancer (FTC) study. We present the first report specifically targeting TSE behaviors among first- and second-degree relatives (n = 99) of affected men from families with ≥ 2 TC cases. Demographic, medical, knowledge, health belief, and psychological factors consistent with the Health Belief Model (HBM) were evaluated as variables related to TSE behavior, using chi-square tests of association for categorical variables, and t-tests for continuous variables.

Results

For men in our sample, 46% (n = 46) reported performing TSE regularly and 51% (n = 50) reported not regularly performing TSE. Factors associated (p < .05) with regularly performing TSE in multivariate analysis were physician recommendation and testicular cancer worry. This is the first study to examine TSE in unaffected men from FTC families.

Conclusion

The findings suggest that, even in this high-risk setting, TSE practices are sub-optimal. Our data provide a basis for further exploring psychosocial issues that are specific to men with a family history of TC, and formulating intervention strategies aimed at improving adherence to TSE guidelines.

Breast self-examination in long-term breast cancer survivors

INTRODUCTION

For many breast cancer survivors, continued surveillance will be necessary to increase the possibility of finding a new diagnosis in an early stage. One such surveillance approach, breast self-examination, has not been studied specifically in breast cancer survivors. The current study was designed to assess the practice of BSE in a sample of long-term breast cancer survivors, and to examine the personal, emotional, cognitive, and health-care provider factors that may contribute to its performance.

METHODS

Three hundred forty-five breast cancer survivors (34% response rate, 345/1,001) diagnosed with in situ-stage II breast cancer between 1997-2004 at a community hospital provided answers to a mailed, self-report questionnaire.

RESULTS

Seventy-six percent of respondents reported that they had performed a BSE in the last 30-days. Forty percent reported performing BSE once/month, 39% more than once/month, and 21% less than once/month since their diagnosis. Most of the women (90%) reported that a doctor or nurse told them to perform a BSE once/month since their diagnosis, although only 69% had actually been shown how to perform a BSE. Consistently, the perception of increased barriers to BSE performance was associated with performance of BSE less than once/month (OR = 1.4, 95% CI 1.2, 1.6; OR = 0.8, 95% CI 0.8, 0.9). In addition, depending on the model, age (OR = 1.1, 95% CI 1.0, 1.2), perceived effectiveness of cancer treatments (OR = 0.7, 95% CI 0.5, 0.9), and perceived benefits of BSE (OR = 0.8, 95% CI 0.7, 0.9) also was associated with differences in BSE performance.

CONCLUSION

The current study suggests that breast cancer survivors between 4 and 11 years from diagnosis practice BSE, although their perception of the barriers to conducting BSE influences the frequency of this behavior. Further examination is needed to understand why some survivors perceive greater barriers to BSE performance than others. Also needed is a prospective examination of BSE performance using behavioral measures in relation to self-report.

IMPLICATIONS FOR CANCER SURVIVORS

Increased attention should be paid to this particular screening behavior performed by a majority of breast cancer survivors by both researchers and health-care providers alike. Whether survivors perform the behavior correctly and the impact it has on their emotional and cognitive well-being should be further explored.

Testicular cancer and genetics knowledge among familial testicular cancer family members

PURPOSE

It was our aim to determine baseline levels of testicular cancer and genetics knowledge among members of families with Familial Testicular Cancer (FTC).

METHODS

This is a sub-study of an ongoing National Cancer Institute (NCI) multidisciplinary, etiologically-focused, cross-sectional study of FTC. We evaluated 258 male and female participants including testicular cancer (TC) survivors, blood relatives and spouses to assess factors associated with a Genetic Knowledge Scale (GKS) and Testicular Cancer Knowledge Scale (TCKS).

RESULTS

Knowledge levels were generally low, with genetic knowledge lower than TC knowledge (p < 0.01). Men with a personal TC history scored highest on TC knowledge, while gender, age and education differentially influenced knowledge levels, particularly among unaffected relatives.

CONCLUSIONS

Prior to identifying FTC susceptibility genes, we recommend tailoring FTC genetic education to the different informational needs of TC survivors, their spouses and relatives, in preparation for the day when clinical susceptibility testing may be available.

Familial testicular cancer: interest in genetic testing among high-risk family members

PURPOSE

This study is part of an ongoing National Cancer Institute multidisciplinary, etiologically-focused, cross-sectional study of Familial Testicular Cancer (FTC). The current report targets interest in clinical genetic testing for susceptibility to FTC.

METHODS

Demographics, knowledge, health beliefs, and psychological and social factors were evaluated as covariates related to interest in genetic testing.

RESULTS

The majority (66%) of 229 participants (64 affected men, 66 unaffected men, and 99 women) from 47 multiple-case FTC families expressed interest in having a genetic test within 6 months, should such a test become available. Interest was similar among the three subgroups mentioned above. Worries about insurance discrimination based on genetic test results were associated with a significantly lower interest in testing. Alternatively, participants were more likely to be interested in genetic testing if they were younger and had higher levels of family support, a physician's recommendation supporting testing, cancer distress, and a need for information to inform the health care of their children.

CONCLUSIONS

This study reveals social and relationship factors that FTC survivors and their relatives considered important when contemplating the use of new genetic technologies. This is the first study describing hypothetical interest in genetic testing for familial testicular cancer.

College students' knowledge of risk and screening recommendations for breast, cervical, and testicular cancers

BACKGROUND

There is a gap in the literature regarding the knowledge of college students about breast, cervical, and testicular cancers.

METHODS

I surveyed 3362 college students were surveyed about their knowledge of risk factors and screening recommendations for these 3 cancers during the 2002-2003 school year at a large public university in the Northeast.

RESULTS

Students knew approximately 50% of the information about risk factors and screening recommendations for these 3 cancers. CONCLUSIONS. Based on these results, college students appear to have limited knowledge about breast, cervical, and testicular cancers and need education about them.

Health locus of control and perceived risk for breast cancer in healthy women

Although early detection is closely linked to survival of breast cancer, many women do not adhere to recommended screening guidelines. One of the most studied factors that contribute to women's screening behavior is their perceived risk of developing breast cancer. In this study, the authors examined contributions of general health locus of control and breast cancer-specific control to understanding perceived risk. Sixty-six healthy women with and without family histories of breast cancer participated in the study. The following were the central findings: (1) internal locus of control and breast cancer-specific control predicted perceived risk, as measured by the certainty of remaining free of breast cancer, and (2) breast cancer-specific control mediated the relationship between internal locus of control and perceived risk. Findings suggest that significant relations between health locus of control and perceived risk variables may be overlooked in the absence of situation-specific measures.

Testicular cancer awareness and self-examination among adolescent males in a community-based youth organization

BACKGROUND

Testicular cancer (TC) is the most common neoplasm affecting males between 15 and 35, and testicular self-examination (TSE) has been recommended for early detection. Studies have found that young adult men have poor awareness of TC and low rates of performing TSE, but little research has examined adolescents.

METHODS

In a comprehensive survey of health behaviors among adolescent boys (n = 213, mean age 15.4 years) who participated in a community-based youth organization (Boy Scouts of America), we assessed whether respondents had heard of TC and the frequency of performing TSE.

RESULTS

Nearly 73% of scouts had heard of TC, but only 10.3% performed TSE at levels consistent with current recommendations (10 or more times per year). Compared to whites, blacks were less knowledgeable about TC and less likely to perform TSE. Knowledge of TC also was associated with participation in physical education classes and the intention to graduate from college. TSE was associated with greater health care access and the use of personal flotation devices during water activities.

CONCLUSION

TSE is underutilized as an early cancer detection tool. Efforts are needed to increase TC knowledge among black adolescents and to integrate TSE education with promotion of healthy behaviors in community organizations.

Adolescent survivors: a secondary analysis of a clinical trial targeting behavior change

BACKGROUND

The late effects of radiation and chemotherapy increase childhood cancer survivors' risk of chronic health problems. Survivors' behavior is important in modifying this risk, yet adolescent and young adult survivors fail to engage in important health-promoting behaviors and frequently practice high-risk behaviors. This secondary analysis re-evaluated a multi-component behavior-change intervention that had previously demonstrated no impact in adolescent survivors of childhood cancer.

PROCEDURE

The parent trial compared 132 adolescent survivors in the intervention arm with 135 in the standard-care arm at baseline and at 1 year for disease and treatment knowledge, perception of late effects risk, and the frequency of health-risk and health-protective behaviors (combined as a single summative measure). In contrast, the secondary analysis examined each of the 14 behaviors separately. Additionally, an analysis of covariance (ANCOVA) was conducted to examine the change in health behaviors while statistically controlling for age, gender, and the wide variation in baseline behaviors.

RESULTS

Knowledge (P = 0.038), breast self-examination (BSE) (P < or = 0.0001) and testicular self-examination (P = 0.004) increased, as did perceptions about the need to change behavior (P = 0.004) and the effort needed to stay healthy (P < or = 0.0001). In the treatment group, junk food consumption decreased (P = 0.052) and smoking abstinence was maintained (P = 0.088). Significant interactions between gender and treatment group were demonstrated.

CONCLUSIONS

Health-risk and health-protective behaviors cannot be effectively combined in a one-dimensional measure. Gender and age influence the impact of interventions targeting health behavior in survivors. Future trials should include observation of the patient-clinician encounter, more complex sampling methods, and pre-trial knowledge of the distribution of the study behaviors.

Development of the self-efficacy for testicular self-examination scale

BACKGROUND

Men between the ages of 20 and 34 years are at highest risk for testicular cancer yet many lack knowledge and confidence in performing self-examination. The Self-Efficacy to Perform Testicular Self-Examination Scale (SEPTSES) is a 7-item questionnaire to be completed by men, which is designed to measure their confidence in self-examining their testicles. The purpose of this methodological study was to determine the validity and reliability of this self-report measure.

METHODS

Content validity of the scale and clarity of items were established with a panel of experts. The SEPTSES and three valid scales of related constructs were completed by two samples of men (homeless [n = 150] and non-homeless [n = 156]) aged 18-34 years.

RESULTS

A single factor explained 51.5% of the variance of the scale and Cronbach's alpha was satisfactory (a = 0.84). Construct validity was further supported by significant correlations with the other three scales; further support was established by a significant difference in mean scores between the two samples [t (303) = -5.44, p < 0.001].

CONCLUSION

The SEPTSES is a valid, unidimensional scale and it can be used in further research and in clinical practice as an assessment of this aspect of men's health.

Common cancers in India: knowledge, attitudes and behaviours of urban slum dwellers in New Delhi

RESEARCH QUESTIONS

What is the level of knowledge and awareness of common cancers? What are the prevalent attitudes and behaviours relating to common cancers?

OBJECTIVES

To assess knowledge, attitudes and behaviours regarding common cancers amongst urban slum dwellers in New Delhi.

STUDY DESIGN

Field-based cross-sectional survey of an urban slum cluster.

SETTING

Slum clusters along Pankha Road, West New Delhi.

PARTICIPANTS

Slum dwellers of selected slums.

STUDY VARIABLES

Independent variables were sociodemographic factors. Dependent variables were knowledge, attitudes and behaviours regarding preventive and curative aspects of common cancers.

STATISTICAL ANALYSIS

Proportions, confidence intervals, tests of significance and multiple logistic regression.

RESULTS

Only 13% (10.6-15.7%) of the study participants were aware of Pap smears, and only 2% (1.1-3.3%) were able to identify all the common signs of cancer. However, 87% (84.4-89.5%) of the study participants knew that tobacco is a risk factor for cancer. Overall, 51% (47.2-54.7%) had some knowledge pertaining to cancer.

CONCLUSION

A focused, concerted and effective information, education and communication drive is urgently needed for all aspects of common cancers in India.

Cancer prevention among rural youth: building a "bridge" to better health with genealogy

BACKGROUND

The Bridge to Better Health (BRIDGE) project is a program that focuses on providing rural high school youth with motivation, knowledge, and skills essential to cancer prevention. In this pilot intervention, we used instruction in personal health genealogy as a means of increasing awareness and knowledge of health risk and motivation to change several screening and cancer-related behaviors.

METHODS

We administered a Bridge to Better Health survey to 173 ninth- and 10th-grade students from a rural Southeastern Virginia high school before and after delivery of the BRIDGE pilot intervention.

RESULTS

Significant preintervention to postintervention changes were observed for general genealogy knowledge, personal health genealogy, self-efficacy, and intention to practice self-examinations (breast, testicular, and skin) and eating a high-fiber and low-fat diet.

CONCLUSION

These project results demonstrate the importance of theory-driven interventions for increasing cancer knowledge and changing cancer-related dietary and screening behaviors.

Breast self-examination: longitudinal predictors of intention and subsequent behaviour

This study analysed in a longitudinal design the relationship between past breast self-examination (BSE) behaviour, determinants, intention and future BSE behaviour in a population of adult Dutch women. Past behaviour and psychosocial determinants were assessed at T1, followed 6 weeks later (T2) with the assessment of the intention to perform BSE monthly. Half a year after the first measurement the current BSE behaviour was assessed by means of a telephone survey (T3) (total end response 78%, n=364). The questionnaires included BSE behaviour, intention, attitude (pros and cons of BSE, anticipated regret, moral obligation), social influence (support, modelling) and self-efficacy. Other background variables assessed were past BSE behaviour, and demographics. Although 81% of the women stated that they performed BSE, only 41% of the women performed BSE correctly. Women who performed BSE correctly differed from women who did not on all psychosocial determinants assessed a half year earlier, with the exception of anticipated regret. Stepwise multiple regression analyses showed that the psychosocial determinants explained 51% of the variance in intention to perform BSE, assessed 6 weeks later; past behaviour accounted for 2% of extra explained variance. Logistic regression analyses showed that past behaviour, the psychosocial determinants and intention were significant predictors of correct BSE behaviour a half year later (Nagelkerke's total explained variance was 47%). It was concluded that misperceptions of correct BSE behaviour was highly prevalent. Both the psychosocial determinants as well as past behaviour were important predictors of intention to perform BSE and subsequent BSE behaviour.

Social psychological correlates of paying attention to cancer symptoms and seeking medical help

Social psychological correlates of two main aspects of the process of cancer detection, viz. passive detection (i.e., paying attention to cancer symptoms) and help-seeking intention, were studied among a-symptomatic Dutch adults. Two written questionnaires, with a six-week interval, identified correlates of both variables, using a determinant model based on the theory of planned behavior. Knowledge, advantages, self-efficacy, being female and being more highly educated were associated with passive detection. Knowledge, advantages, moral obligation, anticipated regret, social norm, and self-efficacy were correlated with the intention to seek help. We suggest that educational programs need to address the two variables separately and also need to tailor their content to the various social psychological correlates of these two aspects.

Teaching testicular self-examination: education and practices in pediatric residents

OBJECTIVE

Although testicular cancer is the most common cancer among 15- to 35-year-old male individuals, physicians seldom conduct testicular self-examination (TSE) education, thus potentially missing opportunities for early detection. Pediatric residents should be learning TSE skills training and be encouraged to incorporate them into routine practice. There are no published studies addressing the medical education and practices of pediatric residents regarding testicular cancer and TSE. The purpose of this study was to determine the prevalence of pediatric residents who teach TSE to their adolescent patients, and significant factors related to teaching TSE.

METHODS

A cross-sectional study was conducted of all pediatric residents at 2 pediatric residency programs during the 2000 to 2001 academic year. A self-administered, 37-item Internet-based questionnaire was developed, pilot-tested, and then used. Statistical analyses included frequency distributions, univariate analysis, correlation coefficient, and logistic regression.

RESULTS

A total of 129 (61%) of the eligible pediatric residents participated. Fourteen (29%) of the male residents reported performing TSE on themselves at least once a month, and 30 (61%) reported performing TSE at least every 3 months. The most frequent reason cited for not performing TSE monthly was "know how, but forget to do it" (97%). Forty (40%) of all residents reported teaching TSE to their 12- to 21-year-old male patients during a routine annual physical examination. The 2 most common reasons for not teaching TSE were "never thought about including it" (36%) and "lack of time" (29%). The senior-level residents reported teaching TSE to their male patients during a routine annual physical examination more often (51%) than the first-year pediatric residents (21%; odds ratio [OR]: 3.99; 95% confidence interval [CI]: 1.5-10.5). There was no difference in teaching TSE between the male residents who report performing TSE (43%) and those who do not perform TSE (37%; OR: 1.27; 95% CI: 0.36-4.5) and between male and female residents (OR: 0.9; 95% CI: 0.44-1.9). There was no association between knowledge of TSE and testicular cancer with teaching TSE or practicing TSE. In a logistic regression model, confidence in testicular examination (OR: 3.1; 95% CI: 1.2-7.9), confidence teaching TSE (OR: 3.6; 95% CI: 1.2-10.9), and knowing someone with testicular cancer (OR: 2.4; 95% CI: 1.0-5.8) were associated with residents' teaching TSE to their patients.

CONCLUSION

Fewer than half of the pediatric residents teach TSE to their adolescent patients. Confidence in performing a testicular examination, confidence in teaching TSE, and knowing someone with testicular cancer were the most important factors related to teaching TSE. This information could be used to design an educational intervention to increase physician promotion of TSE and ultimately increase young males' TSE practices. Additional studies are recommended to determine the generalizability of these results.

Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study

BACKGROUND

Improved cure rates for childhood cancer have produced a growing population of survivors at risk for late toxicities of chemotherapy and radiation therapy. Healthy behaviors can modify these risks. We initiated a controlled prospective trial to determine if a multi-component behavioral intervention could induce change in childhood cancer survivors' health knowledge, health perceptions, and practice of health-protective behaviors.

PROCEDURE

Adolescent cancer survivors attending a long-term follow-up clinic were randomized to receive standard follow-up care or standard care plus the educational intervention. Baseline measures were obtained at randomization (T(0)) and repeated 1 year (T(1)) later during the survivors' annual check-up.

RESULTS

Of 272 patients enrolled and randomized, 251 are evaluable at both time points. Treatment and control groups were similar in regards to diagnosis, gender, race, and age. The change in outcome measures over the year (T(1)-T(0)) was not significantly different between the two groups as assessed by a two-sample pooled t test. However, additional exploratory analyses indicated a significant gender difference in knowledge with female survivors in the intervention group having higher scores. In addition, patients who choose certain individual health goals, such as breast/testicular self-examination, showed improved practice of the health behavior. In addition, in a very exploratory analysis, a gender difference in response to the intervention was noted, with females exhibiting a greater improvement in knowledge scores than did males.

CONCLUSIONS

Although the multi-behavioral educational intervention did not induce change in health knowledge, perceptions, and behaviors of childhood cancer survivors for the treatment group as a whole, gender differences and specific health goal differences were found. These findings suggest that future interventions should be tailored to reflect gender differences and the nature of the health goal under assessment.

Promoting screening and early detection of cancer in men

Gender is a factor in the risk assessment for many diseases. It may also impact on the way in which men assess their personal health or illness status and take action to prevent illness or promote well-being. This paper is focused on three objectives: (i) to foster an understanding of gender differences in health promoting behaviors; (ii) to review three health issues affecting males for which dissemination of health education, increased personal awareness and early detection may be beneficial in the reduction of morbidity and mortality; and (iii) to offer suggestions for nurses and other health care professionals to promote positive patient-provider interactions within a health-care framework for action.

Men's reproductive and sexual health

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.

Psychological impact of endometrial monitoring in tamoxifen-treated postmenopausal breast cancer patients

In view of the higher incidence of endometrial pathology in tamoxifen-treated breast cancer patients, it has been recommended that endometrial surveillance be performed on these women by means of transvaginal sonography. Our study investigated how breast cancer patients experience the endometrial surveillance and which personality factors influence this experience. We also studied compliance with the recommended examination. Fifty-three consecutive asymptomatic postmenopausal breast cancer patients who had taken tamoxifen for at least 6 months were included. Our results show that 23% of the women felt very anxious just before the examination. One woman in five evaluated the procedure as annoying, unpleasant, invasive and awkward, but only 3% found it really unacceptable. Difficulties in coping with mastectomy as well as anxiety negatively affected the experience of the examination. One in six women were doubtful about their ability to comply with such an examination in the future. Women who have difficulties in coming to terms with the mastectomy, anxious women, and women with a low tolerance towards common medical procedures are at especial risk of becoming dropouts. Suggestions are made for developing strategies that might improve these women's compliance.

Men, masculinity, and cancer: risk-factor behaviors, early detection, and psychosocial adaptation

Men and women experience cancer differently. More men than women get cancer, more men than women die from cancer, and men usually adapt less well than women after a cancer diagnosis. In this article, the author suggests that the consequences of male gender-role socialization may explain some of these differences. The focus of the article is on (a) cancer risk-factor behaviors; (b) screening, early detection, symptom recognition, and help seeking; and (c) psychosocial adaptation. Research that has identified gender differences is reviewed and the impact of male gender-role socialization is offered as a potential explanation for these differences. In addition, practice implications for college health professionals are offered.

Feasibility of implementing health promotion interventions to improve health-related quality of life

Survivors of childhood cancer are a growing and vulnerable population. Cure rates for pediatric cancers now exceed 60% and, by the year 2000, an estimated 1 of every 1,000 young adults will be a cancer survivor. Because this population is at increased risk for late medical and neoplastic complications that impact adversely on health-related quality of life, it is important to investigate methods to promote risk reduction by motivating survivors to practice health-promoting behaviors. With this background, we initiated a prospective, randomized, controlled feasibility study in which survivors attending a long-term follow-up clinic were randomized to receive standard care or standard care plus an educational intervention. Our objectives were to determine if the intervention would improve the survivors' knowledge about their cancer treatment and risks of late effects and increase their practice of health-protective behaviors. Since July 1995, 272 of 318 families (86%) approached about the study agreed to participate. Of these, 266 are evaluable for assessment of baseline knowledge and health behaviors. Demographic features, baseline knowledge, health perceptions and health behaviors did not differ among randomized groups. Assessment of the intervention's efficacy at changing health behaviors of survivors randomized to the intervention group will be available when the 1-year follow-up evaluations are completed for the study cohort. Our preliminary experience with this pilot study supports the feasibility of educational intervention research in a specialty clinic dedicated to monitoring long-term childhood cancer survivors. Int. J. Cancer Suppl. 12:138-142, 1999.

Psychological distress, health beliefs, and frequency of breast self-examination

Although monthly breast self-examination (BSE) is recommended for early breast cancer detection, most women do not comply. Few studies have examined the impact of psychological distress on BSE frequency. Recent research suggests that it may be particularly important to examine the role of distress in the recently identified phenomenon of BSE overperformance (> 1/month). One hundred thirty-five healthy women with and without family histories of breast cancer completed sociodemographic, health belief, general and cancer-specific psychological distress, and BSE frequency questionnaires. The central finding of the study was that BSE underperformance and overperformance had two distinct sets of predictors: health beliefs, specifically barriers against BSE and low confidence in BSE performance, were related to BSE underperformance, while higher levels of psychological distress, particularly cancer-specific intrusive thoughts, were related to BSE overperformance. Findings underscore the need to evaluate BSE under- and overperformance separately and to develop problem-specific interventions to increase compliance with monthly BSE.

Identifying male college students' perceived health needs, barriers to seeking help, and recommendations to help men adopt healthier lifestyles

Seven focus groups at a university campus were formed to identify college men's health concerns, barriers to seeking help, and recommendations to help college men adopt healthier lifestyles. Content analysis was used to identify and organize primary patterns in the focus-group data. Results of the study revealed that the college men were aware that they had important health needs but took little action to address them. The participants identified both physical and emotional health concerns. Alcohol and substance abuse were rated as the most important issues for men. The greatest barrier to seeking services was the men's socialization to be independent and conceal vulnerability. The most frequently mentioned suggestions for helping men adopt healthier lifestyles were offering health classes, providing health information call-in service, and developing a men's center. Implications of the results are discussed.

Testicular cancer: testicular self-examination and screening

Testicular cancer represents a significant threat to the health of males aged between 15 and 34 years. As there has been significant focus on early detection of cancers in order to intervene at the earliest opportunity to improve treatment outcomes, the detection of testicular cancer through secondary prevention merits careful consideration. This article discusses two health promotion approaches to dealing with the subject of optimizing men's health: the merits and disadvantages of testicular self-examination education; and screening for testicular tumours in high-risk populations. Recommendations for adapting traditional approaches are also discussed.