A survey of breast cancer awareness and knowledge in a Western population: lots of light but little illumination

Myths and Common Misbeliefs About Colorectal Cancer Causation in Palestine: A National Cross-Sectional Study

PURPOSE

To explore public awareness of myths around colorectal cancer (CRC) causation in Palestine and to examine factors associated with good awareness.

MATERIALS AND METHODS

Convenience sampling was used to recruit adult Palestinians from governmental hospitals, primary health care centers, and public spaces. Recognizing 13 myths around CRC causation was assessed using a translated-into-Arabic version of the Cancer Awareness Measure-Mythical Causes Scale. Awareness level was determined based on the number of CRC mythical causes recognized: poor (0-4), fair (5-9), and good (10-13). Multivariable logistic regression was used to examine the association between sociodemographic characteristics and displaying good awareness. It adjusted for age group, sex, education, occupation, monthly income, residence, marital status, having chronic diseases, being a vegetarian, knowing someone with cancer, and site of data collection.

RESULTS

Of 5,254 participants approached, 4,877 agreed to participate (response rate, 92.3%). A total of 4,623 questionnaires were included in the final analysis: 2,700 from the West Bank and Jerusalem (WBJ) and 1,923 from the Gaza Strip. Only 219 participants (4.7%) demonstrated good awareness of myths around CRC causation. WBJ participants were twice more likely than those from the Gaza Strip to display good recognition (5.9% v 3.1%). Male sex, living in the WBJ, and visiting hospitals were all associated with an increase in the likelihood of displaying good awareness. Conversely, knowing someone with cancer was associated with a decrease in the likelihood of displaying good awareness. Having a physical trauma was the most recognized CRC causation myth (n = 2,752, 59.5%), whereas eating food containing additives was the least (n = 456, 9.8%).

CONCLUSION

Only 4.7% displayed good ability to recognize myths around CRC causation. Future educational interventions are needed to help the public distinguish the evidence-based versus mythical causes of CRC.

Diagnostic Value of Nonacid Nucleic Blood Tumor Marker Panels in Early Diagnosing Breast Cancer: A Systematic Review and Network Meta-Analysis

This study is aimed at determining the best nonacid nucleic blood tumor marker panels in terms of sensitivity, specificity, and accuracy in order to detect breast cancer in early stages (I, II, and III) among eligible women for breast cancer screening. PubMed, Web of Science, Embase, Scopus, and Cochrane were systematically reviewed to assess nonacid nucleic blood tumor marker panels’ diagnostic value in women, both healthy and patient (before any anticancer treatment), for detecting breast cancer. A network meta-analysis was carried out using a Bayesian network meta-analysis to estimate combined odd ratio (OR) and 95% CI credible interval for presenting the results. Rankograms plot was drawn to rank the diagnostic value of different panels. Of the 2358 titles initially identified, 9 studies and 8 panels were included in the network meta-analysis. Panels A (MMP-9/TIMP-1) and K (TF1+TF2+TF3) had the highest sensitivity in early stages, as panel A with $\text{OR}=11.61$ and 95% CI (1.49-102.5) demonstrated a better function than mammography. Panels H (CA 15.3 + IL-18) and A (MMP-9/TIMP-1) had the highest specificity in early stages, but no significant difference with mammography. Panels A (MMP-9/TIMP-1) and H (CA 15.3 + IL-18) had the highest accuracy in early stages, as they significantly exhibited a higher function than mammography with $\text{OR}=6.87$ and 95% CI (2.07-31.35) as well as $\text{OR}=3.44$ and 95% CI (1.15-11.07), respectively. Panel A including MMP-9/TIMP-1 in early stages demonstrated a higher diagnostic value for breast cancer than the rest of the panels.

Knowledge About Gastrointestinal Cancers in People Referred for Endoscopy and Colonoscopy During a Screening Program: a Cross-sectional Study in Guilan, North of Iran

PURPOSE

The most northern and northwestern regions of Iran are at a high risk for gastrointestinal cancers. In this study, we evaluated knowledge of gastrointestinal (GI) cancers in people referred for endoscopy and colonoscopy screening.

METHODS

This cross-sectional study was carried out among 461 people who were under the patronage of a local relief foundation and referred for endoscopy and colonoscopy to the Gastrointestinal and Liver Disease Research Center (GLDRC), Rasht, north of Iran, from March 2016 to March 2017. A well-defined two-sectioned questionnaire was carried out for each group.

RESULTS

Overall, 300 and 161 individuals were in the gastric and colon cancer knowledge group, respectively. The level of knowledge in various areas of gastric and colon cancer was desirable. In general, the average of different domains in gastric and colon cancer knowledge questions were 20.2 ± 6.6 and 19.2 ± 4.9, with the knowledge level higher than the mean in gastric cancer (58%) and colon cancer (67.1%). The mean score of knowledge of GI cancers in terms of risk factor indicated a significant relationship between BMI and alcohol consumption. Meanwhile, a meaningful relationship between symptoms and BMI with knowledge was declared. About domains of colon cancer, there was a significant relationship between younger age and knowledge in the risk factor.

CONCLUSIONS

The results of this study can provide an opportunity to formulate strategies to achieve goals, especially in the field of education, prevention, and control of the disease by raising knowledge for the general public and educating people who are responsible for providing and delivering health services to this community.

Men's Knowledge and Attitudes Towards Breast Cancer: A Descriptive Study

Objective

Breast cancer (BC) is an important disease for women. BC influences both patient's and relatives' lives. Especially, husbands/boyfriends/ lovers are the ones that are affected mostly. In this study, it was aimed to introduce knowledge and attitudes of men toward BC and their sources of information about BC.

Materials and Methods

This descriptive study was conducted with men applied to a University Hospital in Istanbul (Turkey-2018). The ethics permission was obtained from The Clinical Research Ethics Committee. Data regarding socio-demographic characteristics with the knowledge and attitudes towards BC were collected with a questionnaire specific to the research. Statistical significance level was accepted as p<0.05.

Results

In the study, 240 men (mean age: 36.2±10.6 years,min: 18.0, max: 63.0) were interviewed. Fifty four percent of men declared that they would not marry someone with BC and/or someone who had mastectomy. Thirty four percent of participants thought that a woman with BC should conceal the disease. The mean BC knowledge score was 234.1±128.0 (median: 227.5, min: 0, max: 571.0) among the total which was 600.

Conclusion

A significant proportion of men did not have sufficient and accurate knowledge about BC. If the BC knowledge scores increase, there was an association with more positive attitudes. Negative attitudes of men related with BC of a woman may be an indicator of stigmatization. If it is aimed to increase support of men for women dealing with BC, it is recommended that BC awareness activities should be prepared to include men in order to increase their knowledge and to change their attitudes into a more positive way.

The Effect of Counseling on Breast Cancer Awareness in Rural Iranian Women: a Randomized Controlled Clinical Trial

In a community such as Iran where late presentation is predominant and the majority of breast cancer patients are diagnosed at advanced stages of the disease, there is an urgent need for improving the level of awareness about breast cancer and early detection measures. Given that rural residents are at higher risk for late diagnosis of breast cancer because they have less education, income, and access to advanced screening technologies, this study was conducted to determine the effect of counseling on breast cancer awareness of rural Iranian women. This randomized clinical trial was conducted on 60 rural women from the Abish Ahmad area in northwestern Iran in 2017. The randomized cluster method was used for sampling. From 20 rural health houses and centers, about one third were selected randomly. From the six selected clusters, three were randomly allocated as the control group and three as the intervention group. Using convenience sampling, 30 women between the ages of 40 and 69 were selected from the control group and 30 from the intervention group. The intervention group attended six group counseling sessions. Data was gathered using a demographic and obstetrical information questionnaire and breast cancer awareness measures. The chi-square, independent t test and ANCOVA by controlling for the baseline scores were used to analyze the data. After counseling, the mean knowledge about breast cancer score was significantly higher in the intervention group than in the control group (adjusted mean difference, 17.02; confidence interval (CI) 95%, 15.44 to 18.59; p < 0.001). The mean barriers to breast cancer screening score showed a significant decrease in the intervention group compared to the control group (AMD, - 1.74; 95% CI - 3.12 to - 0.36, p < 0.001). After intervention, the frequency of breast self-exam showed a significant difference between groups (p < 0.001); but for confidence about noticing breast changes, no significant difference was observed between groups (p = 0.08). Group counseling had a significant effect on enhancing breast cancer awareness of rural Iranian women, except for confidence about noticing breast changes.

Awareness of cancer risk factors and protective factors among Australian adults

ISSUE ADDRESSED

Up to one-third of incident cancers in Australia are attributable to modifiable factors. Understanding the general public's awareness of cancer risk and protective factors is important for identifying knowledge gaps and informing the development of effective and targeted health promotion strategies.

METHODS

In a telephonic survey of 355 Western Australian adults aged 18-54 years (48% male), with a sample skewed towards low-socio-economic status areas, respondents rated the effect on cancer risk of 11 established cancer risk factors and seven established cancer protective factors.

RESULTS

Most respondents correctly recognised the increased cancer risk from sun tanning (94%), asbestos (92%), pesticide use (92%) and being overweight or obese (86%), and the protective effect of being physically active (82%). Half (52%) of respondents incorrectly believed that red wine decreased or had no effect on cancer risk. One in five respondents (19%) incorrectly believed that sunscreen use increased cancer risk. Only 18% of respondents were aware that human papillomavirus (HPV) vaccination confers a protective effect, while 17% believed it increases risk.

CONCLUSIONS

Although the majority of respondents were aware of certain established cancer risk and protective factors, a sizeable proportion held misconceptions about the cancer risk associated with red wine consumption, sunscreen use and HPV vaccination. SO WHAT?: Health promotion programs designed to educate the public about modifiable cancer risk factors may need to increase public awareness of the safety of preventive factors such as HPV vaccination and sunscreen, and the increased cancer risk from consumption of all alcoholic beverage types, including red wine.

Effects of an Educational Intervention on Breast Self-Examination, Breast Cancer Prevention-Related Knowledge, and Healthy Lifestyles in Scholars from a Low-Income Area in Bogota, Colombia

The aim of this study was to evaluate the effects of an educational intervention on breast self-examination, cancer prevention-related knowledge, practices, and behavior change in scholars from a low-income area in Bogota, Colombia. Uncontrolled trial was conducted in 155 scholars. Two educational sessions, 90 min each, were carried out in March 2015 according to the Colombian guidelines for educational communication in the framework of cancer control. All participants completed a self-reported questionnaire at pre- and post-intervention, as well as 1, 3, and 6 months after the intervention. Breast self-examination was practiced by 78.1% of the scholars, and the overall knowledge of breast cancer risk factors was poor. The educational intervention resulted in significant improvements on breast self-examination practice, the knowledge of the technique, and the knowledge of the main risk factors for breast cancer as well as the practice of physical activity and vegetable intake at 6 months follow-up. An educational intervention according to the Colombian guidelines for educational communication in the framework of cancer control improved the practice of breast self-examination, cancer prevention-related knowledge, as well as the practice of physical activity and vegetable consumption in scholars from a low-income area in Bogota, Colombia. Further randomized controlled studies are warranted.

Explaining between-race differences in African-American and European-American women's responses to breast density notification

BACKGROUND

Prior research shows between-race differences in women's knowledge and emotions related to having dense breasts, thus suggesting that between-race differences in behavioral decision-making following receipt of breast density (BD) notifications are likely. Guided by the theory of planned behavior, this study examined differences in emotion-related responses (i.e., anxiety, worry, confusion) and behavioral cognition (e.g., intentions, behavioral attitudes) following receipt of BD notifications among African American (AA) and European American (EA) women. This study also examined whether race-related perceptions (i.e., discrimination, group-based medical mistrust), relevant knowledge and socioeconomic status (SES) explained the between race differences.

METHOD

Michigan women (N = 457) who presented for routine screening mammogram and had dense breasts, no prior breast cancer diagnoses, and had screen-negative mammograms were recruited from July, 2015 to March 2016. MANOVA was used to examine between race differences in psychological responses (i.e., emotional responses and behavioral cognition), and a multi-group structural regression model was used to examine whether race-related constructs, knowledge and SES mediated the effect of race on emotional responses and behavioral cognition. Prior awareness of BD was accounted for in all analyses.

RESULTS

AA women generally reported more negative psychological responses to receiving BD notifications regardless of prior BD awareness. AA women had more favorable perceptions related to talking to their physicians about the BD notifications. Generally, race-related perceptions, SES, and related knowledge partially accounted for the effect of race on psychological response. Race-related perceptions and SES partially accounted for the differences in behavioral intentions. Between-race differences in emotional responses to BD notifications did not explain differences in women's intentions to discuss BD notifications with their physicians.

CONCLUSIONS

Future examinations are warranted to examine whether there are between-race differences in actual post-BD notification behaviors and whether similar race-related variables account for differences.

Impact of Cancer Awareness Drive on Generating Understanding and Improving Screening Practices for Breast Cancer: a Study on College Teachers in India

Background:

Breast cancer is the most common cancer among women in India and most present at advanced stage. Although early detection is the only way to reduce morbidity and mortality, people have a very low awareness about breast cancer signs and symptoms and screening practices. The purpose of this study was to assess the level of awareness and impact of awareness programs in adoption of safe practices in prevention and early detection.

Methods:

This assessment was part of a pink chain campaign on cancer awareness. During events from 2011 to 2015 at various women colleges in different parts in India, a pre-test of knowledge related to breast cancer was followed by an awareness program. Post-tests using the same questionnaire were conducted at the end of the interactive sessions, at 6 months and after1 year.

Results:

A total of 872 out of 985 teachers participated in the study (overall response rate of 88.5 %). Mean age of the study population was 41.6 years (range 28-59 yrs). There was a significant increase in level of knowledge regarding breast cancer at 6 months and this was sustained at 1 year. Adoption of breast self-examination (BSE) was significantly more frequent in comparison to CBE and mammography. Magazines and newspapers were sources for knowledge regarding screening tests for breast cancer for more than 60% of teachers. Regarding post-awareness at 6 months and 1 year, there was a significant change in alcohol and smoking habits. Major reasons came out to be ignorance (83%) at the start of the campaign which was changed to lack of time (37.7%), lethargic attitude (32.2 %) and lack of time (31.5 %) at 6 months and same at 1 year also.

Conclusions:

With our awareness program there was a significant increase in level of knowledge regarding breast cancer at 6 months and this was sustained at 1 year. Adoption of BSE was significantly greater in comparison to CBE, mammography. To inculcate safe lifestyle practices in people, awareness programmes such as pink chain campaigns should be conducted more widely and frequently.

Evaluation of Breast Cancer Knowledge and Awareness Among Hospital Staff in a Women Heath Hospital in Turkey

The purpose of this study was to examine breast cancer prevention knowledge, beliefs, and information sources among people which are employed in healthcare system including nurses and hospital staff. A cross-sectional survey was conducted among hospital staff of the largest women health hospital in Turkey. Self-administered questionnaires were delivered to participants. A total of 200 hospital staff participated to the study with a response rate of 80.5 %. One-way ANOVA with post-hoc Tukey test was used for multiple comparisons. The results showed that the overall knowledge of hospital staff about breast cancer is inadequate. The mean total knowledge score of the participants was approximately 60 %. The overall mean score of the survey for all participants was 16.69 (SD, 3.12) out of 27. Significant difference was detected in mean total score among educational levels. Education and increasing awareness about the disease can be identified as the major determinants for improving the percentages of early diagnosis and decreasing the mortality rates. Hospital staff education should be the key target for increasing the awareness of whole population especially for developing countries.

The ability of older adults to use customized online medical databases to improve their health-related knowledge

INTRODUCTION

Patient compliance with medical advice and recommended treatment depends on perception of health condition, medical knowledge, attitude, and self-efficacy. This study investigated how use of customized online medical databases, intended to improve knowledge in a variety of relevant medical topics, influenced senior adults' perceptions.

METHOD

Seventy-nine older adults in residence homes completed a computerized, tablet-based questionnaire, with medical scenarios and related questions. Following an intervention, control group participants answered questions without online help while an experimental group received internet links that directed them to customized, online medical databases.

RESULTS

Medical knowledge and test scores among the experimental group significantly improved from pre- to post-intervention (p<0.0001) and was higher in comparison with the control group (p<0.0001). No significant change occurred in the control group.

CONCLUSION

Older adults improved their knowledge in desired medical topic areas using customized online medical databases. The study demonstrated how such databases help solve health-related questions among older adult population members, and that older patients appear willing to consider technology usage in information acquisition.

Influences of race and breast density on related cognitive and emotion outcomes before mandated breast density notification

RATIONALE

Many states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws.

OBJECTIVE

We examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD.

METHODS

We received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD.

RESULTS

Whereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only.

CONCLUSION

We present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants' perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.

Breast cancer literacy among higher secondary students: results from a cross-sectional study in Western Nepal

BACKGROUND

Being the most common cancer among women worldwide, it is vital to be well-aware of breast cancer risk factors, symptoms and curability. However, few studies have reported breast cancer literacy in students using a validated instrument.

METHODS

A cross-sectional study was conducted among students of grades 11 and 12 from eleven higher secondary schools, one selected randomly from each ilaka of Parbat district. Questionnaire with modified Comprehensive Breast Cancer Knowledge Test was self-administered to 516 students. Knowledge score was categorized into two categories: 'good knowledge' and 'poor knowledge' taking median score as the cut-off. Chi-square test was used to determine difference in knowledge by socio-demographic factors, including gender.

RESULTS

Only 4.8% of the students responded correctly to at least half of the items, and 1.4% did not respond correctly to any of the items on risk factors and curability. Physical exercise was identified as a protective factor of breast cancer by 62.4% of the students. Presence of noncancerous breast lumps (56.6%) and being overweight (36.4%) were recognized as the risk factors. Knowledge of lumpectomy and radiation therapy for treatment of breast cancer was reported by 42.8% of students, while only 39.0% were aware of the availability of treatment therapies other than mastectomy. Males were significantly better informed than females (χ(2) = 4.02, p = 0.045). Pain in the breast (23.3 %), change in the shape of the breast (20.0%) and discharge of pus (14.1%) were the three most commonly recognized symptoms. Nearly one in two (47.1%) students indicated that the school curriculum inadequately informed them on breast cancer.

CONCLUSION

Our study demonstrates poor knowledge on breast cancer risk factors, symptoms and curability among higher secondary school students in Western Nepal. Still, several myths regarding breast cancer persist. Half of the students had the perception that school curriculum inadequately informed them on breast cancer. Future studies should aim at the measures necessary to address the inadequate knowledge, along with the perceived gap in school curriculum.

Breast and cervical cancer knowledge and awareness among university students

BACKGROUND

Breast and cervical cancers are the most common types of cancer in women worldwide. Previous studies in Asia have shown that related knowledge and awareness is low among female university students. The goal of this study was to assess breast and cervical cancer knowledge, practices, and awareness among female university students in Samsun,Turkey.

MATERIALS AND METHODS

This research was a cross-sectional survey of female university students using a self-administered. questionnaire to investigate participant awareness and knowledge of breast and cervical cancer. A total of 301 female university students participated. Descriptive statistics and chi square tests were used for data analysis.

RESULTS

The mean age of the participants in this study was 22.0 ± 5.91 years. Regarding family history, 89.7 % of the students had no known familial history of breast cancer. Students (65.4%) had knowledge about breast self examination and 52.2 % of them had performed breast self examinationm while 55.1% of them had knowledge about prevention of cervical cancer.

CONCLUSIONS

Although the results are preliminary, the study points to an insufficient knowledge of university students in Samsun about breast and cervical cancer.

Using the health belief model to predict breast self examination among Saudi women

Background

In the Kingdom of Saudi Arabia, breast cancer (BC) usually presents at advanced stages and more frequently in young pre-menopausal women in comparison to western countries. There is controversy surrounding the efficacy of breast self examination (BSE) for early detection of BC in countries where other methods are available. This study aims to explore the perception towards breast cancer and towards BSE among Saudi women, using the Health Belief Model (HBM).

Methods

A convenient sample of adult Saudi female employees, working at King Abdulaziz Medical City, Riyadh, Saudi Arabia (n = 225), and their non-working adult female family members (n = 208), were subjected to the Arabic version of revised Champion’s Health Belief Model Scale (CHBMS) and the Arabic version of Breast Cancer Awareness Measure (CAM), to assess their knowledge and attitude on BC respectively. Percentage mean score (PMS) for each HBM domain was calculated. Significant predictors of BSE practice were identified using logistic regression analysis and significance was considered at p < 0.05.

Results

The majority of women heard about BSE (91.2 %), only 41.6 % reported ever practicing BSE and 21 % performed it regularly. Reported reasons for not doing BSE were: not knowing how to examine their breast (54.9 %), or untrusting themselves able to do it (24.5 %). Women were less knowledgeable about BC in general, its risk factors, warning signs, nature and screening measures (PMS:54.2 %, 44.5 %, 61.4 %, 53.2 %, 57.6 % respectively). They reported low scores of; perceived susceptibility, seriousness, confidence and barriers (PMS: 44.8 %, 55.6 %, 56.5 % & 41.7 % respectively), and high scores of perceived benefits and motivation (PMS: 73 % & 73.2 % respectively) to perform BSE. Significant predictors of  BSE performance were: levels of perceived barriers (p = 0.046) and perceived confidence (p = 0.001) to BSE, overall knowledge on BC (p < 0.001), work status (p = 0.032) and family history of BC (p = 0.011).

Conclusions

Saudi women had poor knowledge on BC, reported negative attitude towards BSE and their practice was poor. Working women and those with family history of BC, higher perceived confidence and lower perceived barriers on HBM, and those with high level of knowledge on BC were more likely to perform BSE. Breast awareness as an alternative to BSE needs further investigations. HBM was shown as a valid tool to predict BSE practice among Saudi women.

Meta-synthesis exploring barriers to health seeking behaviour among Malaysian breast cancer patients

Barriers to health seeking constitute a challenging issue in the treatment of breast cancer. The current meta- synthesis aimed to explore common barriers to health seeking among Malaysian breast cancer patients. From the systematic search, nine studies were found meeting the inclusion criteria. Data extraction revealed that health behavior towards breast cancer among Malaysia women was influenced by knowledge, psychological, sociocultural and medical system factors. In terms of knowledge, most of the Malaysian patients were observed to have cursory information and the reliance on the information provided by media was limiting. Among psychological factors, stress and sense of denial were some of the common factors leading to delay in treatment seeking. Family member's advice, cultural beliefs towards traditional care were some of the common sociocultural factors hindering immediate access to advanced medical diagnosis and care. Lastly, the delay in referral was one of the most common health system-related problems highlighted in most of the studies. In conclusion, there is an immediate need to improve the knowledge and understanding of Malaysian women towards breast cancer. Mass media should liaise with the cancer specialists to disseminate accurate and up-to-date information for the readers and audience, helping in modification of cultural beliefs that hinder timing health seeking. However, such intervention will not improve or rectify the health system related barriers to treatment seeking. Therefore, there is an immediate need for resource adjustment and training programs among health professional to improve their competency and professionalism required to develop an efficient health system.

Benefits and harms of mammography screening

Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the burden of breast cancer, the benefits and harms of mammography screening have been debated heatedly in the past years. This review discusses the benefits and harms of mammography screening in light of findings from randomized trials and from more recent observational studies performed in the era of modern diagnostics and treatment. The main benefit of mammography screening is reduction of breast-cancer related death. Relative reductions vary from about 15 to 25% in randomized trials to more recent estimates of 13 to 17% in meta-analyses of observational studies. Using UK population data of 2007, for 1,000 women invited to biennial mammography screening for 20 years from age 50, 2 to 3 women are prevented from dying of breast cancer. All-cause mortality is unchanged. Overdiagnosis of breast cancer is the main harm of mammography screening. Based on recent estimates from the United States, the relative amount of overdiagnosis (including ductal carcinoma in situ and invasive cancer) is 31%. This results in 15 women overdiagnosed for every 1,000 women invited to biennial mammography screening for 20 years from age 50. Women should be unpassionately informed about the benefits and harms of mammography screening using absolute effect sizes in a comprehensible fashion. In an era of limited health care resources, screening services need to be scrutinized and compared with each other with regard to effectiveness, cost-effectiveness and harms.

Poor awareness of risk factors for cancer in Irish adults: results of a large survey and review of the literature

BACKGROUND

Knowledge of cancer risk factors is unknown in Ireland. An understanding of risk factors could help inform cancer prevention programs.

AIMS AND METHODS

A 48-question online survey was designed to gather data to assess levels of public knowledge about cancer risk factors.

RESULTS

There were 748 participants (648 women, 100 men). Mean age was 37 years (range: 18-74 years). For the public, 81% were concerned about developing cancer; however, 20% believed that cancer is unavoidable if a family history exists, 27% believed that >50% of cancers are inherited, and 54% believed that 10%-20% of cancers are inherited; 20% were unaware that risk increases with age. The top five risk factors listed by respondents were smoking (87%), diet (76%), genetics (47%), alcohol (42%), and obesity (33%). Only 32% of the public were aware that obesity is a risk factor, and 33% did not think the location of fat was important. Moreover, 29% and 48% believed that risk could be increased by wearing a tight bra and by a blow to the breast, respectively. In addition, 85% and 86% believed that stress and that mobile phones, respectively, "strongly" increase risk; 12% believed that luck is important in avoiding cancer; 35% thought that "detox" diets could reduce risk; and 61% believed that organic food reduces risk. The majority were aware that physical activity of 30 minutes per day can reduce risk.

CONCLUSION

A sizable portion of the population is misinformed about cancer risk. Most participants were aware of classic risk factors (e.g., smoking, diet); however, many overestimated risk attributable to genetics, environment, and stress and underestimated age, obesity, and sunlight. One in seven participants believed that lifetime risk of cancer is not modifiable.

Public awareness of cancer risk factors in the Moroccan population: a population-based cross-sectional study

BACKGROUND

In Morocco, knowledge of cancer risk factors, a crucial element in the process of behavioral change, has never been evaluated. This study aims to provide information on the level of awareness of cancer risk factors among the Moroccan general population.

METHODS

A cross sectional survey was carried out in May 2008, using a stratified sampling method in a representative sample of the Moroccan adult population. The used questionnaire included social and demographic data as well as questions about 14 cancer related factors regarding passive or active smoking, alcoholic beverages, obesity, physical inactivity, food coloring, red meat, fat, salt, fruit, vegetables, olive oil, green tea, coffee, breast-feeding. Subjects had to choose between 3 propositions for each proposed factor (risk factor/Protective factor/Don't Know). The knowledge score was calculated by summing the correct answer for each proposed factor except coffee and food coloring. The answer was assigned 1 if it's correct or 0 if it was incorrect or the participant responded 'don't know. The maximum knowledge score was 12. Multivariate linear regression model was used to evaluate the determinants of knowledge score.

RESULTS

Among 2891 subjects who participated to the survey, 49.5% were men and 42% were from a rural area. The mean age was 41.6 ± 15.2 years. The mean knowledge score of cancer related factors was 8.45 ± 3.10 points. Knowledge score increased with educational level (β = -0.65 if school year ≤6 versus >6) and housing category (β = 1.80 in high standing housing vs rural housing). It was also higher in urban area, among never smokers and among people never consuming alcohol compared to others groups.

CONCLUSION

These results provide valuable information necessary to establish relevant cancer prevention strategies in Morocco aiming to enhance and improve people's knowledge about risk factors especially in some target groups.

Perception of breast health amongst Malaysian female adolescents

BACKGROUND

Breast cancer is the most common cancer among women in Malaysia, about one in 19 women being at risk. This study aimed to investigate knowledge and practice of breast self-examination (BSE), as well as knowledge of risk factors for breast cancer amongst female adolescents in Malaysia. Subsequently, relationships between demographic characteristics and knowledge level of BSE, risk factors for breast cancer and BSE practice were assessed.

MATERIALS AND METHODS

A descriptive, cross sectional survey was conducted using a sample of 500 Malaysian adolescents from the age of 15 to 19 years. A self-administered questionnaire was used to gather socio- demographic characteristics, knowledge of BSE, knowledge of risk factors for breast cancer and BSE practices.

RESULTS

The findings of this study indicated that female adolescents in Malaysia demonstrated an inadequate knowledge level of BSE and risk factors for breast cancer. Only 27.8% of female adolescents performed BSE regularly. BSE practice, knowledge of BSE and knowledge of risk factors for breast cancer showed significant positive relationships.

CONCLUSIONS

The study highlighted the importance of planning and implementing breast health education programs for female students in secondary schools in Malaysia. It will also provide the health care providers an avenue to stress on the importance of imparting breast health education to adolescents.

General public awareness of heart failure: results of questionnaire survey during Heart Failure Awareness Day 2011

INTRODUCTION

General public views about heart failure (HF) alone and in comparison with other chronic conditions are largely unknown; thus we conducted this survey to evaluate general public awareness about HF and HF disease burden relative to common chronic disease.

MATERIAL AND METHODS

This was a cross-sectional survey during European Heart Failure Awareness Day 2011. People visiting the stands and other activities in 12 Slovenian cities were invited to complete a 14-item questionnaire.

RESULTS

The analysis included 850 subjects (age 56 ±15 years, 44% men, 55% completed secondary education or higher). Overall, 83% reported to have heard about HF, 58% knew someone with HF, and 35% believed that HF is a normal consequence of ageing. When compared to other chronic diseases, HF was perceived as less important than cancer, myocardial infarction, stroke and diabetes with only 6%, 12%, 7%, and 5% of subjects ranking HF as number 1 in terms of prevalence, cost, quality of life, and survival. A typical patient with HF symptoms was recognized by 30%, which was comparable to the description of myocardial ischemia (33%) and stroke (39%). Primary care physicians (53%) or specialists (52%) would be primary sources of information about HF. If experiencing HF, 83% would prefer their care to be focused on quality of life rather than on survival (14%).

CONCLUSIONS

Many participants reported to have heard about heart failure but the knowledge was poor and with several misbeliefs. Heart failure was perceived as less important than several other chronic diseases, where cancer appears as a main concern among the general public.

Assessing the level of breast cancer awareness among recently diagnosed patients in Ain Shams University Hospital

Breast cancer is the leading female malignancy among Egyptian women. The majority of Egyptian breast cancer patients present at late stages of the disease with a large tumor size compared to Western countries. Low breast cancer awareness, social and cultural factors were suggested to play crucial role in late presentation of breast cancer among Egyptians. The aim of our present study is to establish a questionnaire-based survey that can assess levels of breast cancer awareness among Egyptians. Patients enrolled were interviewed and answered 60 questions related to knowledge, symptoms, risk factors, prevention and management options of breast cancer. We evaluated our interactions with breast cancer patients and defined the level of awareness gained from education and culture of Egyptian women. Our results described that Egyptian breast cancer patients lack knowledge about their illness and condition. The lowest levels of awareness were related to age, education and culture. We concluded that breast cancer public awareness and women education programs covering factors identified in our study is warranted among Egyptian population. Overview

OBJECTIVE

To assess breast cancer awareness among recently diagnosed breast cancer Egyptian patients.

SUBJECTS AND METHODS

Among 289 interviewed breast cancer patients we enrolled 45 patients who fulfilled the study inclusion criteria. Participants were asked to answer a validated 60-item questionnaire that inquires about socio-demographic characteristics, knowledge of breast cancer symptoms, risk factors, symptoms, prevention, general management and willingness to participate in awareness campaigns. The average of interview time was about 45 min, depending on patient's age and education level.

RESULTS

The mean age of included patients was 48.2 ± 10.19 years. Geographical distribution revealed that 66.7% patients were from Cairo and the rest were from other governorates, including Aswan, Sharqia, Mansora, Qena, Kalyobia, Elminya and Sohag. Among interviewed patients 85% were non-working housewives, 42.2% of them were illiterate. Questions about knowledge of breast cancer revealed that 53.33% of patients knew an acquaintance with breast cancer; however, they spent a median time of 3 months to seek medical advice after recognizing the first symptom with a delay range between a month and 72 months. We found that 73% of the participants presented to a physician with the same first recognized symptom and 75.6% didn't think of cancer then as a possible diagnosis. Total breast cancer knowledge scores had an average of 13.3 (out of 35 knowledge points), with 93% of the patients recognizing "painless breast mass" as a breast cancer symptom and 44% only recognized the concept of breast self examination. Interestingly, 61.4% identified breastfeeding as a risk factor for breast cancer, 60% did not recognize mammography as an early detection method, and 57.7% agreed that clinical breast examination (CBE) is important for early detection. Regarding management, 75% said breast cancer was potentially curable and 60% said medical care could be helpful regardless the age of presentation.

CONCLUSION

Egyptian breast cancer patients knew little about their condition. Less awareness was related to age and education level. Low knowledge of risk factors, early detection and management of breast cancer should be addressed by designing patient education programs, where less educated patients are supported by health care professionals to participate in the management of breast cancer. Moreover, we found that 67% and 97% of enrolled breast cancer patients were willing as well to participate in spreading awareness among their community and among their own families, respectively.

The effectiveness of a community-based breast cancer education intervention in the New York State Capital Region

We determined the effectiveness of a community-based breast cancer education intervention among understudied populations in the New York State (NYS) Capital Region by assessing and comparing baseline and post-education breast cancer knowledge. Participants included 417 students recruited from five colleges/universities and 67 women from four community group organizations. Baseline and post-education knowledge was assessed via self-administered mostly multiple-choice questionnaires. An open-ended question soliciting opinions about public health prevention strategies against breast cancer was included on college/university students' questionnaires. Effectiveness of education intervention was estimated through a paired t test. Stratified analysis was done using demographic and descriptive variables. Answers to the open-ended questions were analyzed qualitatively. The mean percentage of correct answers increased from 39.9% at baseline to 80.8% post-education (P < 0.0001) among college/university students and from 43.5% to 77.8% (P < 0.0001) among community group members. Effectiveness remained statistically significant in all stratified analyses with similarly high percentage of correct answers achieved post-education irrespective of knowledge level at baseline. Stratified analysis also revealed similar patterns of improvement in overall knowledge and narrowing of the gap in post-education knowledge. Primary prevention emerged as the dominant theme post-education in students' responses to the open-ended question, signifying the effectiveness of our education in raising awareness about modifiable risk factors and inspiring proactive thinking about public health prevention strategies. This community-based education intervention was effective in increasing breast cancer knowledge among demographically diverse groups with low levels of baseline knowledge in the NYS Capital Region. Our findings provide leads for future public health prevention strategies.

Shedding light on women's help seeking behaviour for self discovered breast symptoms

PURPOSE

To describe women's help seeking behaviour (HSB) and the associated influencing factors on self-discovery of a breast symptom.

METHODS

A descriptive, correlational survey design was used. Following ethical approval, survey data were collected from women (n = 449) attending the breast clinics of two large urban hospitals within the Republic of Ireland.

RESULTS

The majority of women (69.9%; n = 314) sought help (by visiting their General practitioner, GP) within one month, 30.1% (n = 135) delayed help seeking for more than one month following symptom discovery and 16.7% (n = 75) delayed for three months or more. The factors most significantly associated with delayed HSB were knowledge around symptom identity (Odds Ratio (OR) = 4.80, p = 0.005); ignoring the symptom and hoping it would go away (OR = 10.72, p < 0.001) and women's belief that the symptom would persist for a long time (OR = 1.18, p = 0.023). Being afraid on symptom discovery (OR = 0.37, p = 0.005) was associated with reduced risk of delayed HSB.

CONCLUSIONS

It is encouraging to see that the majority of women who find a breast symptom seek help promptly. However, a small cohort of women delay seeking help from their GP. HSB is influenced by multiple factors which can impact on patient outcomes. Findings are important for oncology nurses who have a key role to play in promoting breast awareness, prompt help seeking and early detection and treatment of breast cancer, amongst women.

Women's awareness of cancer symptoms: a review of the literature

Improvements in cancer detection and treatment have led to consistent declines in mortality from many cancers. However, many patients present for treatment at a point where more invasive treatment is required and/or treatment outcomes are less than optimal. One factor that has been consistently shown to be associated with late diagnosis and treatment is delay in seeking help for symptoms. This paper reviews the literature on women's awareness of cancer symptoms and aims to identify knowledge gaps that need to be addressed in order to improve help-seeking behaviors. The discovery of substantial gaps in awareness suggest a need for improved community education regarding cancer symptoms.

Awareness of breast developmental anomalies: a study in Jamasi, Ghana

Background

Few global studies investigating breast developmental anomalies (BDA) among young females have been conducted. This study aimed to evaluate the degree of BDA awareness among young females in central Ghana.

Methods

In February 2008, clinical breast examination was performed for both breasts of female volunteers at five selected junior high schools (JHS) in Jamasi, Ghana. Anonymous pretested questionnaires were administered to those found to have BDA.

Results

Of the 600 female students surveyed, 78 (13%) were found to have BDA. All 78 females completed the questionnaire. The respondents ranged in age from 12 to 21 years (mean 15.3 years). Most of the respondents (83%) had some knowledge of BDA. Although 63% had been aware of their own BDA for 1–3 years before the survey; 78% did not know the cause of their BDA. According to their self-reports, BDA had no influence on the schooling of 78.2% or the family of 70.5% of the respondents.

Conclusion

Awareness of BDA among the JHS females in Jamasi is high. Appropriate education and treatment should be encouraged for continual management of a high awareness level for BDA.

Breast cancer messaging for younger women: gender, femininity, and risk

Evidence linking both active smoking and secondhand smoke exposure to premenopausal breast cancer makes the development of health messages specific to younger women a pressing priority. To determine how to communicate information about this modifiable breast cancer risk to young women, we analyzed a selection of 32 recent English-language breast cancer messages and campaigns that targeted young women. In addition, we obtained young women's responses to three breast cancer campaign images during focus group discussions. A visual analysis of messages points to an explicitly gendered discourse within contemporary campaigns, one that entails conflicting messages regarding breast cancer, health, feminine beauty, and risk. Although the intent might be to educate and empower young women to "fight" against breast cancer, paradoxically, the messages employ imagery that sexually objectifies young women's breasts and bodies. Recommendations are made for messaging about tobacco and breast cancer risk to avoid reproducing one-dimensional or stereotypical presentations of gender and femininity.

Australian women's awareness of breast cancer symptoms and responses to potential symptoms

OBJECTIVES

Poor awareness of breast cancer symptoms has been associated with patient delay in seeking help; thus reduced survival, more aggressive treatment, and fewer treatment choices. The aim of this study was to develop a representative picture of Australian women's knowledge of symptoms, experienced potential symptoms, and behavioral responses.

METHODS

A general population sample of approximately 3,000 women aged 30-69 completed a telephone survey; results were compared to previous surveys conducted in 1996 and 2003.

RESULTS

The most commonly cited potential symptom of breast cancer was a lump in the breast, identified by 86% of respondents (an increase from 75% in 2003). Other commonly mentioned symptoms were discharge from the nipple, pain/soreness, skin puckering, or dimpling; and a change in breast shape. The proportion unable to name any potential symptoms of breast cancer decreased from one in ten in 2003 to approximately one in twenty in 2007. The primary reason for not seeking medical advice in response to a potential symptom was the belief that breast cancer was not present.

CONCLUSIONS

Health promotion efforts need to continue to aim at increasing community understanding of potential breast cancer symptoms and encouraging women to act on potential symptoms by seeking medical advice.

The relationship between health information sources and mental models of cancer: findings from the 2005 Health Information National Trends Survey

This study used data from the 2005 Health Information National Trends Survey, a national sample of U.S. households (N = 5,586), to (1) explore the extent to which specific sources of health information are associated with certain beliefs about cancer; and (2) examine whether the relationship between health information sources and beliefs about cancer is moderated by psychological distress. Health information on the local news was associated with greater ambiguity about cancer prevention recommendations (OR 1.22, 95% CI 1.02-1.46, p < .05), while less ambiguity was associated with cancer-specific information (OR 0.81, 95% CI 0.69-0.94, p < .05), health information in the newspaper (OR 0.82, 95% CI 0.69-0.97, p < .05), and health information on the Internet (OR 0.71, 95% CI 0.61-0.84, p < .001). Health information on the local news was also associated with lower likelihood of higher perceived relative risk of cancer (OR 0.67, 95% CI 0.52-0.86, p < .01). No source of information was associated with the belief that cancer is primarily caused by behavior/lifestyle factors. Psychological distress greatly increased the optimistic bias of those who read health information in the news (OR 3.68, 95% CI 1.69-8.03, p < .001) but had no other moderating effect. Findings suggest that information seeking using active channels of health information decreases ambiguity and corrects for optimistic bias.

Men and women: beliefs about cancer and about screening

Background

Cancer screening programmes in England are publicly-funded. Professionals' beliefs in the public health benefits of screening can conflict with individuals' entitlements to exercise informed judgement over whether or not to participate. The recognition of the importance of individual autonomy in decision making requires greater understanding of the knowledge, attitudes and beliefs upon which people's screening choices are founded. Until recently, the technology available required that cancer screening be confined to women. This study aimed to discover whether male and female perceptions of cancer and of screening differed.

Methods

Data on the public's cancer beliefs were collected by means of a postal survey (anonymous questionnaire). Two general practices based in Nottingham and in Mansfield, in east-central England, sent questionnaires to registered patients aged 30 to 70 years. 1,808 completed questionnaires were returned for analysis, 56.5 per cent from women.

Results

Women were less likely to underestimate overall cancer incidence, although each sex was more likely to cite a sex-specific cancer as being amongst the most common cancer site. In terms of risk factors, men were most uncertain about the role of stress and sexually-transmitted diseases, whereas women were more likely to rate excessive alcohol and family history as major risk factors. The majority of respondents believed the public health care system should provide cancer screening, but significantly more women than men reported having benefiting from the nationally-provided screening services. Those who were older, in better health or had longer periods of formal education were less worried about cancer than those who had illness experiences, lower incomes, or who were smokers. Actual or potential participation in bowel screening was higher amongst those who believed bowel cancer to be common and amongst men, despite women having more substantial worries about cancer than men.

Conclusion

Our results suggest that men's and women's differential knowledge of cancer correlates with women's closer involvement with screening. Even so, men were neither less positive about screening nor less likely to express a willingness to participate in relevant screening in the future. It is important to understand gender-related differences in knowledge and perceptions of cancer, if health promotion resources are to be allocated efficiently.

Public awareness of gastric cancer risk factors and disease screening in a high risk region: a population-based study

PURPOSE

This study involved a population-based survey to provide evidence of public awareness of risk factors of gastric cancer and to investigate attitudes for the screening of gastric cancer in the South Korean population.

MATERIALS AND METHODS

Using a nationwide random selection method, 2014 subjects were enrolled in the study between 5 September 2006 and 25 September 2006.

RESULTS

In terms of the awareness of risk factors, awareness was scored as the percentage of the probability of developing gastric cancer when a subject had a particular risk factor. For the risk factors, stress ranked highest with a score of 73.5%, followed by chronic gastritis (score of 72.1%), gastric ulcer (score of 71.2%) and a previous gastrectomy history (score of 68.7%). Other factors included a diet of charred foods (score of 67.3%), alcohol use (score of 65.3%), salty diet (score of 65.1%), history of smoking (score of 64.3%) and Helicobacter pylori infection (score of 57.5%). Subjects believed that 60.4% of all gastric cancers were preventable by lifestyle modification and the subjects believed that regular screening could prevent 72.1% of all gastric cancers. However, 54% of subjects did not receive regular screening and the most common reason for not undergoing screening was a lack of symptoms.

CONCLUSION

Public education about the risk factors of gastric cancer and of lifestyle modifications and the importance of regular screening regardless of the presence of symptoms should be emphasized to reduce gastric cancer mortality in South Korea.

Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria

Background

Breast cancer is the leading female malignancy in Nigeria. Screening for early detection has led to reduction in mortality from the disease. It is known that attitudes of physicians and motivation by community nurses influence uptake of screening methods by women. This study aims to investigate knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among a cohort of female healthcare professionals in Lagos, Nigeria.

Methods

A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among 207 female doctors, nurses and other healthcare professionals working in a university teaching hospital in Lagos, Nigeria. Stratified random sampling method was employed. Chi square test, analysis of variance and Mantel-Haenszel test were performed in data analysis using SPSS v10.0 and Epi Info version 6 statistical packages.

Results

Female doctors obtained a mean knowledge score of 74% and were the only professional group that had satisfactory knowledge of risk factors. Majority (86%) believed that early breast cancer is curable while half of participants believed that prayer can make breast cancer disappear from the affected breast. Eighty three percent practice breast self-examination (BSE) once a month and only 8% have ever had a mammogram. Age, knowledge of risk factors, profession and beliefs were not significantly associated with rate of BSE in this study.

Conclusion

Results from this study suggest the need for continuing medical education programmes aimed at improving knowledge of breast cancer among female healthcare providers other than doctors.

Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods

BACKGROUND

Breast cancer remains an important public health problem. This study aimed to investigate about female knowledge of breast cancer and self-reported practice of breast self-examination in Iran.

METHODS

This was a population-based survey carried out in Tehran, Iran. Data were collected via a structured questionnaire containing 15 questions on demographic status, history of personal and family breast problems, subjective knowledge about breast cancer covering its symptoms, the screening methods and practice of breast self-examination (BSE). A trained female nurse interviewed each respondent. Analysis included descriptive statistics and the Chi-squared test where necessary.

RESULTS

A total of 1402 women were interviewed. The mean age of respondents was 43.4 (SD = 14.4) years; most were married (85%), and without any personal (94%) and family history (90%) of breast problems. It was found that 64% of the respondents were familiar with breast cancer and 61% (n = 851) believed that 'the disease is relatively common among women in Iran'. Most women (44%) perceived a painless mass as a breast cancer symptom. Overall, 61% of the respondents stated that they knew about breast cancer screening programs and most indicated that electronic media (television 34% and radio 14%) were their source of information. Only 17% of women said that 'they were conducting regular breast self-examination'. The main reason for women not doing breast self-examination was due to the fact that they did not know how to do it (64%). The findings indicated that performing breast self-examination is significantly related to: age, marital status, education, knowledge of breast cancer and knowledge about breast cancer screening programs (p < 0.05), but not to personal (P = 0.2) and family (P = 0.7) history of breast problems.

CONCLUSION

This descriptive study provides useful information that could be utilized by both researchers and those involved in public health programmes. The findings indicated that the women awareness of breast cancer warning signs (painless lump, retraction of nipple, and bloody discharge) and effective screening methods i.e. clinical examination, and mammography were very inadequate. Thus, health education programmes to rectify the lack of women awareness is urgently needed. Indeed the focus of primary health care providers should be to raise awareness about breast care among women and to encourage them to report any unusual changes in their breasts to their family or care physicians.

The information needs of men with breast cancer

The information needs of men with breast cancer are under-researched. This article uses questionnaire data from 161 men with breast cancer, and in-depth interview data from a sample of 30 of these men, to explore perceptions of information needs and how best to meet these needs. These men typically received verbal information or written information in the form of leaflets or booklets. Generally this information was helpful, was pitched at about the right level and contained the right amount of information, but was of variable relevance given that it had not been developed specifically for men. Men with breast cancer would benefit from receiving gender-specific information, given the limitations of existing information sources. Of all healthcare professionals, breast care nurses were described as being most helpful in terms of providing both information and practical support.

Rapid assessment breast clinics – Evolution through audit

This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.

Low levels of breast cancer risk awareness in young women: an international survey

At least a fifth of breast cancer cases in Western countries are likely to be due to modifiable lifestyle factors. Previous work has found that while women in Western countries are aware that breast cancer can be hereditary, their knowledge of the influence of lifestyle is poor. This survey investigated on the awareness of breast cancer risk factors in university students from 23 countries between 1999 and 2001. Data were collected on awareness of links with heredity, alcohol use, exercise, obesity, stress, smoking and diet. Almost a third of women were not aware that any of these factors influenced breast cancer. Just 57% were aware of the genetic link and fewer than 1 in 20 women correctly identified alcohol, exercise or obesity as factors influencing breast cancer. Stress and smoking were the most commonly chosen lifestyle risk factors although current data suggest that they have little actual impact on breast cancer risk. There was considerable international variation, with highest levels of awareness in students in the United States of America (USA). Knowledge of risk in this sample was poorer than previously observed in older women. Health messages concerning cancer in general may be more relevant for this age group, because of the lower salience of breast cancer for younger women.

Public awareness of risk factors for cancer among the Japanese general population: a population-based survey

BACKGROUND

The present study aimed to provide information on awareness of the attributable fraction of cancer causes among the Japanese general population.

METHODS

A nationwide representative sample of 2,000 Japanese aged 20 or older was asked about their perception and level of concern about various environmental and genetic risk factors in relation to cancer prevention, as a part of an Omnibus Survey. Interviews were conducted with 1,355 subjects (609 men and 746 women).

RESULTS

Among 12 risk factor candidates, the attributable fraction of cancer-causing viral and bacterial infection was considered highest (51%), followed by that of tobacco smoking (43%), stress (39%), and endocrine-disrupting chemicals (37%). On the other hand, the attributable fractions of cancer by charred fish and meat (21%) and alcohol drinking (22%) were considered low compared with other risk factor candidates. For most risk factors, attributable fraction responses were higher in women than in men. As a whole, the subjects tended to respond with higher values than those estimated by epidemiologic evidence in the West. The attributable fraction of cancer speculated to be genetically determined was 32%, while 36% of cancer was considered preventable by improving lifestyle.

CONCLUSION

Our results suggest that awareness of the attributable fraction of cancer causes in the Japanese general population tends to be dominated by cancer-causing infection, occupational exposure, air pollution and food additives rather than major lifestyle factors such as diet.