Knowledge and perceptions about breast cancer incidence, fatality and risk among Australian women

Worldwide review with meta-analysis of women's awareness about breast cancer

OBJECTIVE

To summarize the awareness levels of breast cancer (BC) worldwide and investigate factors associated with BC awareness to determine differences in awareness between China and other countries.

METHODS

This systematic review followed the PRISMA guidelines and included 92 articles up to July, 2021. We calculated percentages for BC awareness levels and conducted subgroup analysis and cumulative meta-analysis.

RESULTS

A total 84% (95% confidence interval [95%CI]: 78-90%) of women knew about BC; however, only 51% (95%CI: 37-66%) and 40% (95%CI: 24-56%) of women were aware of BC symptoms and BC risk factors, respectively. The most commonly known BC symptom was breast lump (71%, 95%CI: 62-80%), and BC family history was the most well-known BC risk factor (61%, 95%CI: 54-69%). Subgroup analysis showed lower awareness levels among Chinese and Asian women than women from other countries. Cumulative meta-analysis showed no obvious progress in BC awareness levels over time. We investigated 15 awareness-related factors, the most frequent of which were education level (61.8%), occupation (29.4%), and age (26.5%).

CONCLUSION

BC awareness levels remain low. Improving BC awareness is critical, especially in developing countries.

PRACTICE IMPLICATIONS

Effective education programs are urgently needed to improve women's BC awareness.

Bladder Cancer and Google Trends: Associations Between US Search Patterns and Disease Outcomes May Show Need for Improved Awareness Strategies

Interest in and awareness of bladder cancer may translate to better health-seeking behaviors and earlier detection, given modifiable risk factors such as smoking. We assessed bladder cancer interest in the USA over the past 15 years as reflected by Internet search trends, and correlated these trends with epidemiologic patterns in bladder cancer. Google Trends was used to estimate US bladder cancer interest in the unit search volume index (SVI), which estimates the volume of online search activity for a specified period relative to the highest volume of searches within a specified location. Between January 2004 and June 2019, SVIs were collected for the search term "bladder cancer" and other related search terms. To evaluate the effect of public awareness campaigns, the SVIs for the month of May (US bladder cancer awareness month) were compared with the SVIs of all other months. Correlations between "bladder cancer" SVI and incidence, mortality, and mortality-to-incidence ratio (proxy for survival) by state were evaluated. There was no increase in the relative search volumes for "bladder cancer" during the national bladder cancer awareness month compared with all other months (p = 0.27). By state, there were positive correlations between SVIs of "bladder cancer" and incidence (R = 0.72, p < 0.001) and mortality (R = 0.47, p < 0.001). However, there was no correlation between SVIs and mortality-to-incidence ratio (R = - 0.24, p = 0.08). Interest in bladder cancer is positively associated with disease incidence and mortality but not survival, suggesting interest is driven by new diagnoses or deaths, and not early detection that can improve survival. Our findings may show the need for better public education endeavors.

Knowledge, Attitudes, and Beliefs About Breast Cancer and Barriers to Breast Self-Examination Among Sikkimese Women

Objectives: The objectives of this study are to assess women's awareness on breast cancer; and their awareness, attitudes, and barriers to practice of breast self-examination (BSE). Methodology: This cross-sectional study was conducted from May 1, 2015 to June 30, 2015, involving 302 women between 18 and 65 years of age attending the Outpatient Department of Central Referral Hospital, Gangtok. Face-to-face semi-structured questionnaire-based interview was conducted among the participant women, after taking their written consent. Results: Three-fourths of the participants were aware of breast cancer. Eighty percent of the women who had heard about breast cancer were not aware of its risk factors. Forty-six percent of the participants were aware of BSE. Most common source of knowledge was from health professionals. Of the 138 women who were aware of BSE, 41.3% ever practiced BSE. Majority had started BSE between 21 and 45 years of age. Thirty-seven percent of the participants practiced BSE once in a year. Working women and students were found to be twice more likely to practice BSE compared to homemakers. Similarly, women belonging to lower socioeconomic status were 70% less likely to practice BSE than women of affluent class. Conclusions: Knowledge of the breast cancer and BSE practices is poor among indexed Sikkimese reproductive women attending tertiary hospital of Sikkim. There is an urgent need for information on the airwaves and in print, and for education at health centers on warning symptoms of breast cancer and various methods of screening for breast cancer including BSE.

Breast Cancer Knowledge and Screening Practice and Barriers Among Women in Madinah, Saudi Arabia

A breast screening program may help to reduce cancer mortality rates among women. However, the use of the screening program by women in Madinah city is low, and studies examining its practice and barriers of low uptake are sparse. To identify breast cancer knowledge, practice and screening barriers among women attending primary health centers (PHC) in Madinah, Saudi Arabia. A primary health center-based cross-sectional study was performed in Madinah city in 2015. A multistage stratified cluster sample was obtained and included 465 women (15 years and older) from five PHC. Data concerning socio-demographics, knowledge about breast cancer, and practice and barriers of mammography use were collected using a structured questionnaire. The mean age of the studied 465 women was 34.9 ± 12.2 years. Of these women, 27.7 and 38.5 % received mammography and performed breast self-examination, respectively. A high level of poor knowledge about breast cancer was detected in the overall studied women and those who never received a mammography, particularly knowledge related to the risk factors of breast cancer. The most important predictors of the barriers to mammography were incorrect beliefs about mammography and its procedures. A belief that mammography is painful was significantly associated with a 56 % reduction in its use (OR = 0.44; 95 % CI = 0.22-0.88). The high levels of poor knowledge about cancer breast observed in this study reflect the need for greater efforts to increase breast awareness education.

Breast Cancer Awareness among Women in Western Amazon: a Population Based Cross-Sectional Study

Background:

A general lack of women`s awareness of breast cancer has been one of the barriers to screening and early presentation. Thus, the aim of this study was to evaluate levels of knowledge about risk factors, and early warning signs of breast cancer, and to determine factors associated with better levels of comprehension.

Methods:

A population-based cross-sectional study was carried out among 478 women over 40 years old, living in Rio Branco city, western Amazon. All were interviewed using the “Breast cancer knowledge, attitudes and practice scale”, developed by American Cancer Society.

Results:

Among the respondents, only 28.6% of women were aware that advanced age highly increases the risk. Around 30% of participants recognized nipple retraction as a sign of breast cancer. Breast cancer knowledge varied according to age in such a way that the mean scores were high from 40-69 years and decreased dramatically among those aged ≥70 (β=-0.06, p=0.031). Access to health services such as the Pap-test (β=2.45, p=0.027) and attending a gynecologist in the past two years (β=1.88, p=0.005) were statistically associated with the score of breast cancer knowledge.

Conclusion:

The findings indicate that women living in urban areas, having gynecological assessment, considering herself at high risk of developing breast cancer and thinking that breast cancer is a fatal disease are statistically associated with good knowledge of breast cancer risk factors, signs and symptoms, even adjusting for age and education.

Public Perceptions on Cancer Incidence and Survival: A Nation-wide Survey in Korea

PURPOSE

The aim of this study was to compare the public perceptions of the incidence rates and survival rates for common cancers with the actual rates from epidemiologic data.

MATERIALS AND METHODS

We conducted a survey of Korean adults without history of cancer (n=2,000). The survey consisted of questions about their perceptions regarding lifetime incidence rates and 5-year survival rates for total cancer, as well as those of eight site-specific cancers. To investigate associated factors, we included questions about cancer worry (Lerman's Cancer Worry Scale) or cared for a family member or friend with cancer as a caregiver.

RESULTS

Only 19% of Korean adults had an accurate perception of incidence rates compared with the epidemiologic data on total cancer. For specific cancers, most of the respondents overestimated the incidence rates and 10%-30% of men and 6%-18% of women had an accurate perception. A high score in "cancer worry" was associated with higher estimates of incidence rates in total and specific cancers. In cancers with high actual 5-year survival rates (e.g., breast and thyroid), the majority of respondents underestimated survival rates. However, about 50% of respondents overestimated survival rates in cancers with low actual survival rates (e.g., lung and liver). There was no factor consistently associated with perceived survival rates.

CONCLUSION

Widespread discrepancies were observed between perceived probability and actual epidemiological data. In order to reduce cancer worry and to increase health literacy, communication and patient education on appropriate risk is needed.

Breast Cancer: The Perspective of Northern Nigerian Women

Background:

The rising incidence of breast cancer is complicated by late presentation, which marks breast cancer diagnosis in Nigeria with about 70% of cases presenting at advanced stages of the disease. The aim of this study is to determine the general level of awareness of breast cancer, breast cancer risk factors, signs/symptoms as well as preventive measures nothern Nigerian women. It also aimed at determining their attitudes toward breast cancer cure, prevention and cause. Finally, it aims to determine their practices toward breast cancer and its associated factors.

Methods:

A cross-sectional community survey was used to study 230 women aged 15–60 years in Chikun Local Government Area. The subjects were selected based on nonprobability sampling. Data collected using self-administered questionnaire were analyzed using Statistical Package for Social Science students (version 16). Test of associations employed Chi-square statistical tool with the level of significance taken at 0.05.

Results:

About 75.2% knew about breast cancer with health facility (29.13%) being the greatest source of information. An average of 29.35% had knowledge of the risk factors tested. Mean knowledge of the signs and symptoms was 50.1% Average knowledge of breast cancer screening methods was 34.26% with breast self-examination (BSE) (46.1%) being the most recognized. In relation to perception, about 21.7% strongly agreed with the fact that breast cancer is treatable following early detection while 18.3% strongly agreed that screening is effective in detecting breast cancer. Concerning practice, an average of 10.2% practiced any of the screening methods, with BSE (17.4%) being the most practiced. Strongest reasons for nonpractice was ignorance (17.4%). An association was established between knowledge and practice of all the screening methods (P = 0.001 respectively).

Conclusions:

There is insufficient knowledge, as well as poor practices in relation to important factors associated with breast cancer prevalence.

Knowledge, perception, and attitudes about cancer and its treatment among healthy relatives of cancer patients: single institution hospital-based study in Saudi Arabia

This study was conducted to assess knowledge, perception, and attitudes regarding cancer and treatment among healthy relatives of cancer patients who attended an outpatient cancer clinic with their relatives who suffer from cancers. The participants recruited in this cross-sectional, interview-based study were 846 (557 female and 289 male subjects) healthy relatives of cancer patients from the outpatient cancer clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Most of the participants answered that they believed the causes of cancer were genetic (44.90 %), followed by environmental factors (30.10 %), diet (26.90 %), other causes (26.90 %), envy (26.90 %), and black magic (17.60 %). Most of the healthy participants believed that doctors should tell patients the full truth about the diagnosis (83.57 %). More than half of the healthy population stated that cancer patients should accept all types of treatment (chemotherapy and/or radiotherapy and/or surgery), with more male subjects having this position than females (P = 0.014). Most of the participants believed that cancer cannot be caught from another person who suffered from cancer (67.50 %). Most of the participants believed that cancer education was sufficient (66.70 %), with a significant difference between male and female respondents (P = 0.004). With regard to why cancer patients hide their disease, most of the participants in the age group <25 years believed that the causes were fear of loss of health insurance (56.20 %), followed by job loss (34.40 %), and then social stigma (9.40 %); in the age group between 25 and 45 years, the causes were fear of loss of health insurance (76.50 %), followed by social stigma (14.70 %), and then job loss (8.80 %); while in the age group >45 years, the reasons were job loss (47.10 %), followed by health insurance loss (41.20 %), and then social stigma (11.80 %), with a significant difference between groups (P = 0.034). This study demonstrated that still a large number of healthy participants had deficient perceptions and poor attitudes about important issues concerning cancers such as different mode of treatments, alternative treatment, biological causes, and prognosis, particularly among male respondents. Prevention education strategies should be considered, including targeted approaches that aim to reduce disparities in cancer perception among the general population.

Public perceptions of cancer risk factors: a Western Australian study

ISSUE ADDRESSED

People's perceptions of risk may influence health-related behaviours. The aim of this study was to investigate the perception of cancer risk factors among Western Australian adults in order to inform health promotion policies.

METHODS

Cross-sectional surveys of 2094 adults were undertaken in 2007/2008 in which respondents were asked whether they thought factors increased or decreased the risk of cancer. Factors included both established and unestablished risk factors for cancer. The distribution of perceptions was compared according to age and sex.

RESULTS

The study found high levels of endorsement for some unestablished risk factors (74-91%) and comparatively lower levels of endorsement for many established risk factors (33-80%). The established risk factors of smoking and asbestos received high levels of endorsement (94-98%).

CONCLUSION

It appears that the alignment between scientifically established risk factors and the Western Australian public's perception of cancer risk factors could be improved. SO WHAT? Health promotion strategies are needed to improve the public's awareness of cancer risk factors. The high levels of endorsement attributed to unestablished risk factors highlight the need to dispel myths surrounding cancer and to reinforce the key factors in cancer prevention. Ongoing assessment of the alignment between community perceptions of cancer risk and the scientific evidence for cancer risk is important for guiding prioritisation within public health organisations.

Evaluation of awareness of risk factors for kidney cancer among patients presenting to a urology clinic

OBJECTIVE

This study aimed to evaluate awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Smoking, obesity and hypertension are widely accepted as risk factors for kidney cancer; however, there are limited data regarding awareness of these risk factors.

MATERIAL AND METHODS

The researchers prospectively identified 172 patients presenting to a urology clinic between 1 May 2009 and 31 August 2009. Each patient completed a questionnaire that requested responses to whether certain lifestyle factors increased the risk of a variety of cancers. Information on demographics and other covariates was collected via questionnaires and medical chart abstraction. To estimate and compare risk factor awareness levels for different cancers, 95% confidence intervals (95% CIs) were constructed and Fisher's exact tests performed. Logistic regression analysis was used to evaluate covariates associated with risk factor awareness.

RESULTS

The percentage reporting that smoking increases the risk of kidney cancer (36%, 95% CI 29-44%) was lower than for lung cancer (96%, 95% CI 92-99%). Similarly, the percentage reporting that obesity increases the risk of kidney cancer (32%, 95% CI 25-40%) was lower than for colon cancer (45%, 95% CI 37-53% CI). Only 18% (95% CI 13-25%) identified hypertension as a risk factor for kidney cancer. Female gender and younger age were associated with increased levels of awareness of the association with smoking and obesity, respectively.

CONCLUSION

The data support a low level of awareness of kidney cancer risk factors and underscore an opportunity for urologists to engage in education efforts.

Literacy and breast cancer prevention: a population-based study from Iran

Breast cancer is the most common cancer in women worldwide and the leading cause of death from cancer among women. Evidence suggests that early diagnosis and screening interventions might help to improve outcomes. This population-based study was conducted to determine breast cancer awareness and screening behavior among Iranian women and to examine its association with women's literacy. The study was carried out in two provinces, with 1,477,045 population, located in central and eastern part of Iran. Overall, 770 women were studied. Of these, 482 (62.7%) were literate and 287 (37.3%) were not. The results obtained from the data analysis indicated that there was a significant difference between literate and illiterate women. Further analysis of the data using logistic regression showed that literacy was an important contributing factor for breast cancer prevention behavior. The findings suggest that in order to improve women's health and breast cancer outcomes providing equal educational opportunities for women seems necessary.

Australian women's perceptions of breast cancer risk factors and the risk of developing breast cancer

BACKGROUND

Numerous studies have shown that the majority of women overestimate both their own risk and the populations' risk of developing breast cancer. A number of factors have been found to correlate with perceived risk.

METHODS

This paper reports on a telephone survey of a nationally representative sample of approximately 3,000 Australian women aged 30 to 69 years, conducted in 2007, and compares the findings with those of a similar survey conducted in 2003.

RESULTS

There was a clear tendency for respondents to overestimate the proportion of women who will develop breast cancer during their lifetime. Approximately half the respondents perceived themselves as being at the same risk of developing breast cancer as other women their age; older respondents were more likely to perceive themselves to be at a lower than average risk. Family history was recognized as a risk factor for breast cancer, although there was evident confusion in relation to risk from paternal family history. It was also evident that the association between age and risk status is poorly understood, and misconceptions of breast cancer risk factors identified in the previous survey persisted in 2007.

CONCLUSION

Overall, these results suggest that there remains an educational challenge if we seek to increase the accuracy of women's perceptions of their risk for developing breast cancer, primarily in relation to the significance of age and family history as breast cancer risk factors.

Evaluation of breast cancer awareness among female university students in Malaysia

Breast cancer is the most common cancer and the leading cause of cancer death among women of all ethnic and age groups in Malaysia.

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.

Big gap between risk perception for breast cancer and risk factors: nationwide survey in Korea

OBJECTIVE

To explore perceived risk of breast cancer among Korean women and to investigate factors associated with perceived risk of breast cancer.

METHODS

A telephone survey using random digit dialing was conducted with an age- and region-stratified random sample of women in Korea. The study population consisted of 1000 women who participated in telephone surveys in which a 21-item questionnaire was administered.

RESULTS

This study showed a significant level of comparative optimism in breast cancer risk perception in Korean women with an average risk of breast cancer. According to the multivariate analysis, younger age, family history of breast cancer, and history of benign breast disease were the factors associated with higher perceived comparative risk of breast cancer.

CONCLUSION

The finding that a limited number of breast cancer risk factors were related to perceived risk of breast cancer is worrying because women with other risk factors for breast cancer may believe themselves to be at lower risk.

PRACTICE IMPLICATIONS

It is necessary for women to understand their risk factor profiles to avoid biased optimism or pessimism.

Awareness of lifestyle risk factors for cancer and heart disease among adults in the UK

OBJECTIVE

To examine and compare awareness of lifestyle risk factors for cancer and heart disease in a single UK representative sample.

METHODS

Two open-ended questions about cancer and heart disease risk factors were included in a population-based survey of 1747 adults. Responses were coded for four lifestyles with established links to both diseases: smoking, eating an unhealthy diet, drinking excessive alcohol and physical inactivity.

RESULTS

Awareness of lifestyle risk factors was low for both diseases, although higher for heart disease than cancer. The average number identified by respondents was 2.1 (heart disease) and 1.4 (cancer). The strongest predictor was education (both p<0.001). Awareness that physical inactivity is a cancer risk factor was particularly low at 7%.

CONCLUSION

These findings suggest that public awareness of the impact of lifestyle on commonly feared diseases, especially cancer, is low.

PRACTICE IMPLICATIONS

Unhealthy lifestyles make a significant contribution to ill health and mortality. Increased public awareness of the links between lifestyles and commonly feared diseases might help people understand the potential health consequences of their actions and encourage them to make much-needed lifestyle changes. Efforts are needed to improve public health messages about how lifestyle risk factors impact on the chances of developing these important diseases.

People's perceptions of cancer survivability: implications for oncologists

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

Knowledge, attitude and practice of Nigerian women towards breast cancer: a cross-sectional study

Background

Late presentation of patients at advanced stages when little or no benefit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women. Recent global cancer statistics indicate rising global incidence of breast cancer and the increase is occurring at a faster rate in populations of the developing countries that hitherto enjoyed low incidence of the disease. Worried by this prevailing situation and with recent data suggesting that health behavior may be influenced by level of awareness about breast cancer, a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Nigeria towards breast cancer.

Methods

One thousand community-dwelling women from a semi-urban neighborhood in Nigeria were recruited for the study in January and February 2000 using interviewer-administered questionnaires designed to elicit sociodemographic information and knowledge, attitude and practices of these women towards breast cancer. Data analysis was carried out using Statistical Analysis Software (SAS) version 8.2.

Results

Study participants had poor knowledge of breast cancer. Mean knowledge score was 42.3% and only 214 participants (21.4%) knew that breast cancer presents commonly as a painless breast lump. Practice of breast self examination (BSE) was low; only 432 participants (43.2%) admitted to carrying out the procedure in the past year. Only 91 study participants (9.1%) had clinical breast examination (CBE) in the past year. Women with higher level of education (X² = 80.66, p < 0.0001) and those employed in professional jobs (X² = 47.11, p < 0.0001) were significantly more knowledgeable about breast cancer. Participants with higher level of education were 3.6 times more likely to practice BSE (Odds ratio [OR] = 3.56, 95% Confidence interval [CI] 2.58–4.92).

Conclusion

The results of this study suggest that community-dwelling women in Nigeria have poor knowledge of breast cancer and minority practice BSE and CBE. In addition, education appears to be the major determinant of level of knowledge and health behavior among the study participants. We recommend the establishment and sustenance of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer to all women in Nigeria.

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

There are conflicting data on breast cancer awareness and knowledge in specific population groups. We assessed awareness and knowledge of breast cancer in the general Irish population to identify sources of information on breast cancer and determine factors associated with knowledge and awareness of the disease. Participants (n=2355, 53% female) completed a multi-part questionnaire. Most (81%) had seen or heard something about breast cancer in the recent past and knowledge of symptoms and treatment was good overall. However, 66% of females overestimated their risk of developing disease, 88% underestimated the age at which it was most likely to develop and 56% underestimated 5-year survival. Knowledge of incidence and survival was higher in males (Odds Ratio (OR) 1.3, 95% Confidence Interval (CI); 1.1-1.5), participants with higher education (1.5; 1.2-1.7) and those who received information from television (1.3; 1.1-1.5). Ignorance regarding incidence, outcome and risk makes it unlikely that the general public or at risk females could currently make informed decisions on a range of breast cancer issues.

Economics and health promotion

Health promotion activities consume a growing proportion of health sector spending in most developed countries. Yet, there is still considerable debate in the non-economic literature about exactly what health promotion constitutes and precisely how its role is to be conceived. This paper provides one economic answer to such questions. It sets out an argument that health promotion may be viewed, through the lens of traditional welfare economics, as a response to problems of market failure. A Grossman-type health investment model is invoked to analyse individual deviations from equilibrium and the possible instruments and targets of health promotion policy. The paper concludes by suggesting some of the alternative conceptual approaches that might be brought to bear, as well as some ideas for empirical research.

Awareness of breast cancer incidence and risk factors among healthy women

The efficacy of early breast cancer detection programmes seems to be mainly influenced by the awareness of breast cancer in general among healthy women. This study aimed to provide information about women's understanding of breast cancer incidence and risk of disease. Based on a newly developed questionnaire 2108 healthy women were asked about their knowledge and perceptions in relation to breast cancer incidence, risk factors, risk perception and level of concern. Of these women 78.8% were well aware of breast cancer in general terms. However, there were major aspects such as incidence or risk factors that were poorly understood. Only one-third correctly estimated the incidence of breast cancer; 95% understood breast cancer in the familial history as a risk factor, but only 57% understood the age risk; 37.1% of women perceived hormonal contraceptives and 35.9% hormonal replacement therapy as risk factors of breast cancer. The latter estimation was significantly higher in women above 40 years. Recommendations for the improvement of cancer prevention programmes include targeting understanding of lifetime risk of breast cancer, age as a risk factor, survival from breast cancer or hormonal factors. There is a need to separately address the perceptions of women depending on age, social status and educational levels.

Associations between perceived cancer risk and established risk factors in a national community sample

INTRODUCTION

Perceptions of personal cancer risk may not accurately reflect individual's exposure to established risk factors. The purpose of this study was to assess associations between perceived cancer risk and selected established risk factors, using a large nationally representative sample.

METHODS

We used data from the 2000 National Health Interview Survey (NHIS) to perform a cross-sectional analysis of 30,223 adults without a cancer diagnosis. Multinominal logistic regression analyses were used to assess factors associated with medium and high perceived cancer risk.

RESULTS

The effects of age, family history, and smoking status on perceived risk were linear and more pronounced on those with high perceived risk. High perceived risk was associated with every day smoking (relative risk ratio [RRR] = 4.27, 95% confidence intervals [CI] = 3.65-5.01), alcohol consumption (e.g. RRR = 1.26, 95% CI = 1.01-1.56 for current drinker), number of relatives with cancer (e.g. RRR = 20.64, 95% CI = 16.37-26 for those with both parents positive), low income (RRR = 1.25, 95% CI = 1.08-1.45), and female (RRR = 1.39, 95% CI = 1.23-1.57). Obesity (RRR = 1.32, 95% CI 1.1-1.6), but not overweight, was identified as an independent determinant. High perceived risk was inversely related to age (e.g. RRR = 0.19, 95% CI = 0.16-0.24 for adults 60 and older). Ethnic minorities were less likely to perceive cancer risk. Physical inactivity was not associated with high perceived risk.

CONCLUSIONS

Among established risk factors, family history appears to be most reflected in the single measure of perceived cancer risk. The relationship between perceived cancer risk and exposure to established risk factors differs in important ways from what public campaigns have communicated with the public. Prevention messages should highlight that cancer risk increases with age and certain modifiable risk factors, including overweight and physical inactivity. The relationship between cancer risk perceptions and ethnicity merits further exploration.

Coverage of breast cancer in the Australian print media--does advertising and editorial coverage reflect correct social marketing messages?

Early detection of breast cancer by mammographic screening has the potential to dramatically reduce mortality rates, but many women do not comply with screening recommendations. The media are an important source of health information for many women--through both direct social marketing advertisements and indirect dissemination of information via editorial content. This study investigated the accuracy of breast cancer detection messages in the top-selling Australian women's magazines and three weekend newspapers in the six-month period from December 2000 to May 2001 that included any reference to breast cancer and found that current coverage of breast cancer in the Australian print media conveys messages that are unlikely to encourage appropriate screening.

Influence of 'framing effect' on women's support for government funding of breast cancer screening

OBJECTIVES

To explore whether Australian women's support for government funding of mammographic screening is influenced by 'framing effect'.

METHOD

Self-administered survey of 701 women in general practice to elicit their support for government funding of each of four mammographic screening programs where benefits were expressed as a relative risk reduction (RRR); absolute risk reduction (ARR); number needed to screen (NNS) and number of cases detected for additional death avoided.

RESULTS

The proportion of respondents indicating they 'definitely would support funding' was significantly greater when benefits were expressed as RRR than ARR (chi 2(1) = 148.4, p < 0.0001), NNS (chi 2(1) = 126.4, p < 0.0001) or number of cases detected for additional deaths avoided (chi 2(1) = 29.0, p < 0.0001). 55.8% of women were not influenced by 'framing effect'. Younger women and those with higher educational levels were more likely to be susceptible to 'framing effect'.

CONCLUSION

Having demonstrated its influence among these women, 'framing effect' should be acknowledged in future research.

Women's perceptions of breast cancer risk: are they accurate?

BACKGROUND

The objective was to compare women's personal estimates of their risk with objective breast cancer risk estimates and to describe the risk factors for breast cancer identified by women.

METHODS

Telephone survey of a random sample of 761 rural and urban women with no history of breast cancer. Survey instrument included measures of perceptions of lifetime risk for breast cancer for themselves and for the average woman, perceptions of risk factors that influenced their risk and the average woman's risk for breast cancer. Objective estimates of breast cancer risk were calculated using the Gail et al. algorithm. Descriptive statistics and multiple linear regression were used to analyze the data.

RESULTS

Women's estimates of their own lifetime risk for breast cancer were significantly higher than their Gail model risk estimates (mean difference = 19%, p < 0.001). The women's personal breast cancer risk estimates were lower than estimates of risk for a hypothetical average woman (mean difference = -8%, p < 0.001). Fifty percent of the sample reported a perceived risk estimate at least 15% above their Gail risk estimate. The risk factors for breast cancer most frequently identified included family history, nutrition/diet, smoking, lifestyle, environment, stress and age. Although the risk factors used to calculate the Gail model risk estimates were reported by some study participants, these women consistently identified only family history as their personal risk factor.

CONCLUSION

Women have difficulty accurately estimating their breast cancer risk and identifying known risk factors for breast cancer. Individual risk information may be more useful in enhancing accurate risk perceptions than the "1 in 9" message.

Skin cancer prevention and detection practices among siblings of patients with melanoma

BACKGROUND

Family members of patients with melanoma have an increased risk of the disease, and families with multiple affected members account for about 10% of melanoma cases. These statistics suggest that first-degree relatives of patients with melanoma, who are at particularly high risk, warrant targeted public health action.

OBJECTIVE

We sought to document rates for dermatologist examinations for cutaneous lesions, the practice of skin self-examination, and sunscreen use in this at-risk group.

METHODS

Before participation in a randomized trial, 404 siblings of recently diagnosed patients with melanoma completed a survey on beliefs and practices regarding skin cancer prevention and detection.

RESULTS

Sixty-two percent of participants had carefully examined their skin, 54% routinely used sunscreen, and 27% had received a skin cancer examination by a dermatologist during the past year; 47% had never received a dermatologist examination. Multivariate analysis found modifiable positive predictors for skin self-examination and dermatologist examinations, including having a clinician with whom to talk about melanoma and believing in the importance of regular skin examinations by a physician. Significant modifiable negative predictors included enjoyment of being tanned, not being sure what to look for when examining moles, and feeling uncomfortable having others look at their skin.

CONCLUSIONS

Skin self-examination rates among these high-risk siblings are markedly higher than in population-based studies. However, many siblings were not screened for skin cancer by a dermatologist despite having strong risk profiles, being nearly fully insured, and being under care of primary care physicians. Improvements in communication between physicians and high-risk families and changes in office systems to assess family history of melanoma could increase screening rates for the estimated 1 million siblings of patients with melanoma.

Mammograms and Pap Smears for Australian Deaf Women

This study aimed to assess baseline knowledge about mammograms and Pap smears among Australian Deaf women, to investigate their participation in breast and cervical cancer screening services, and to explore, where relevant, their perceptions about their access to breast and cervical screening services. An interview schedule was developed, and a convenience sample of 13 Deaf women was interviewed face-to-face by the first researcher with an accredited Auslan interpreter. The Deaf women's knowledge about mammograms and Pap smears often was incomplete. However, most of the eligible women had undergone a mammogram and had been rescreened within the recommended time frame. Although most had received a Pap smear, some were not attending as recommended by the Cancer Council of Australia. This exploration into the experiences of Deaf women can prompt all nurses to consider the needs of particular minorities and the barriers they may face to participate fully in health services.

Knowledge, attitudes, and practices surrounding breast cancer screening in educated Appalachian women

PURPOSE/OBJECTIVES

To determine how and what women learn about breast cancer and screening practices and which factors influence women's breast cancer screening practices.

DESIGN

Descriptive analysis of questionnaire data collected at the time of enrollment in a clinical trial.

SETTING

Breast care center of a mid-Atlantic academic health sciences center.

SAMPLE

185 women in a predominantly Appalachian, entirely rural state.

METHODS

Participants completed the Modified Toronto Breast Self-Examination Inventory and questions related to personal mammography practices at the time of enrollment before randomization in a longitudinal clinical intervention study.

MAIN RESEARCH VARIABLES

Women's demographics, knowledge of breast cancer screening practices, adherence to breast cancer screening guidelines, and motivation, knowledge, and practice proficiency surrounding breast cancer screening.

FINDINGS

These educated women had knowledge deficits about breast cancer, breast cancer risk factors, and screening guidelines, particularly the timing and practice behaviors of breast self-examination. Women who had received healthcare and cancer-screening instruction by healthcare providers, including advanced practice nurses, had greater knowledge of breast cancer and detection practices.

CONCLUSIONS

Women still have knowledge deficits about breast cancer, breast cancer detection, and personal risk factors. In addition, some educated women in this study failed to practice breast cancer screening according to current guidelines.

IMPLICATIONS FOR NURSING

Practitioners must continue to remind and update women about breast disease, and women's cancer-screening practices must be reinforced. All levels of providers should improve their rates of performing clinical breast examinations with physical examinations. Nurses, who greatly influence women's health care, must remain current in their knowledge of breast disease, screening, and treatment.

Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom

BACKGROUND

Colorectal cancer (CRC) mortality is high. Understanding the social, psychological, and cognitive predictors of early detection practices such as screening may help improve CRC outcomes. This study examined knowledge of CRC and the relationship between knowledge, attitudes to cancer, and intentions to engage in early detection behaviors for CRC in a national representative population sample.

METHOD

An interview-based survey was carried out in a British population sample of adults ages 16 to 74 years (n = 1637), assessing knowledge, attitudes, and intention with regard to colorectal cancer.

RESULTS

Knowledge levels were very low; 58% (n = 995) of respondents could not list any colorectal cancer risk factors and 24% (n = 393) were unable to identify any warning signs for cancer. Knowledge was lower among men (chi(2)[2] = 52.8, P < 0.0001), younger respondents (chi(2)[10] = 79.9, P <.0001), and those with less education (chi(2)[4] = 73.9, P < 0.0001). Attitudes to cancer were more negative among women (chi(2) [2] = 7.4, P = 0.025), younger participants (chi(2)[10] = 22.4, P = 0.013), and those with less education (chi(2) [4] = 75.0, P < 0.0001). Low knowledge was associated with negative attitudes (P < 0.0001) and both factors were associated with lower intentions to participate in colorectal cancer screening (P < 0.0001). Multivariate analysis indicated that attitudes partially mediated the effect of knowledge on screening intentions.

CONCLUSIONS

Increasing knowledge may reduce negative public perceptions of cancer which may impact positively on intentions to participate in screening.

Developing and testing lay literature about breast cancer screening for African American women

Written materials about breast cancer screening for African American women with low literacy skills are needed. Available materials were not at or below third-grade reading levels, were not culturally sensitive, and were not accurate in illustrating correct breast self-examination (BSE) techniques. Focus groups representing the target population helped the authors design a pamphlet describing how to perform BSE and a motivational picture book to help women overcome barriers to screening. The authors chose a food theme for the cover of the pamphlet written at a third-grade level and suggested a photographic version. In the motivational book, two women address barriers to screening and replace myths and fears with facts and actions. Data from 162 women showed that they learned from both the photographic and illustrated versions. Women in the photographic group found significantly more lumps in the silicone models, so the authors chose that version to use in final testing. Finally, nurses pretested a group of patients before they reviewed the materials and post-tested another group after they reviewed them. The group who had reviewed the materials had greater knowledge of and intent to follow the guidelines and received higher scores on BSE techniques.

Women's knowledge and beliefs regarding breast cancer

Approximately 20-30% of women delay for 12 weeks or more from self-discovery of a breast symptom to presentation to a health care provider, and such delay intervals are associated with poorer survival. Understanding the factors that influence patient delay is important for the development of an effective, targeted health intervention programme to shorten patient delay. The aim of the study was to elicit knowledge and beliefs about breast cancer among a sample of the general female population, and examine age and socio-economic variations in responses. Participants were randomly selected through the Postal Address File, and data were collected through the Office of National Statistics. Geographically distributed throughout the UK, 996 women participated in a short structured interview to elicit their knowledge of breast cancer risk, breast cancer symptoms, and their perceptions of the management and outcomes associated with breast cancer. Women had limited knowledge of their relative risk of developing breast cancer, of associated risk factors and of the diversity of potential breast cancer-related symptoms. Older women were particularly poor at identifying symptoms of breast cancer, risk factors associated with breast cancer and their personal risk of developing the disease. Poorer knowledge of symptoms and risks among older women may help to explain the strong association between older age and delay in help-seeking. If these findings are confirmed they suggest that any intervention programme should target older women in particular, given that advancing age is a risk factor for both developing breast cancer and for subsequent delayed presentation.

Knowledge and perception about stroke among an Australian urban population

BACKGROUND

The aim of the study was to measure knowledge about the symptoms, prevalence and natural history of stroke; the level of concern about having a stroke; understanding of the possibilities for preventing stroke, and the relationship between age, sex, country of origin, educational level, income, self-reported risk factors, and the above factors.

METHODS

A random sample of households was selected from an electronic telephone directory in Newcastle and Lake Macquarie area of New South Wales, Australia, between 10 September and 13 October 1999. Within each household the person who was between 18 and 80 years of age and who had the next birthday was eligible to participate in the study (1325 households were eligible). The response rate was 62%.

RESULTS

The most common symptoms of stroke listed by respondents were "Sudden difficulty of speaking, understanding or reading" identified by 60.1% of the respondents, and "paralysis on one side of body" identified by 42.0% of the respondents. The level of knowledge of the prevalence of a stroke, full recovery after the stroke, and death from stroke was low and generally overestimated. 69.9% of the respondents considered strokes as being either moderately or totally preventable. There were few predictors of knowledge.

CONCLUSION

The study suggests that educational strategies may be required to improve knowledge about a wide range of issues concerning stroke in the community, as a prelude to developing preventive programmes.

Women's interest in genetic testing for breast cancer susceptibility may be based on unrealistic expectations

We report on results of an interview study assessing women's attitudes toward and hypothetical interest in genetic susceptibility testing for breast cancer. Data are from 246 interviews with women of varying ethnicity (African American, European American, Native American, and Ashkenazi Jewish), family history of breast cancer (negative, positive, and borderline), and educational level. Semistructured interviews included questions on general health beliefs; attitudes, experiences, and concerns about breast cancer; and hypothetical interest in genetic testing. Influence of specific test characteristics was assessed with 14 Likert scales varying negative and positive predictive value, timing of disease, possible medical interventions following a positive result. Results reported include both statistical and qualitative analysis. We found that women had a high level of interest in testing which, in general, did not vary by ethnicity, level of education, or family history. Interest in testing appeared to be shaped by an exaggerated sense of vulnerability to breast cancer, limited knowledge about genetic susceptibility testing, and generally positive views about information provided through medical screening. However, study participants were most interested in a test that didn't exist (high positive predictive value followed by effective, noninvasive, preventive therapy) and least interested in the test that does exist (less than certain positive predictive value, low negative predictive value, and limited, invasive, and objectionable therapeutic options). Our data suggest that without a careful counseling process, women could easily be motivated toward interest in a test which will not lead to the disease prevention they are seeking.