Public awareness of cancer in Britain: a population-based survey of adults

*_Objective:_* To assess public awareness of cancer warning signs, anticipated delay, and perceived barriers to seeking medical advice in the British population. 
Methods: We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the Cancer Awareness Measure (CAM), a newly-developed, validated measure of cancer awareness. The sample included 2216 adults (970 male and 1246 female) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling.

*_Results:_* Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socioeconomic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help-seeking were difficulty making an appointment, worry about wasting the doctor’s time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay.

*_Conclusions:_* A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes

Regional clinical registry data show increased incidence of cutaneous melanoma in Cape Town

Cutaneous melanoma is a skin tumour that continues to result in a high mortality rate, particularly in the case of thick tumours and those that are deeply invasive histologically. It occurs in all populations but is most common in fair-skinned individuals, especially those with skin types 1 and 2 that tan poorly or not at all. There is epidemiological evidence for the pathogenetic role of ultraviolet light, particularly intense childhood exposure, although the relationship is complex. Genetic factors also play a role, as exemplified by families with both atypical naevi and melanoma. The rising incidence of melanoma, noted initially in countries with high levels of UV light, appears to be levelling off or decreasing in some areas. The pattern of these trends is inconsistent, with even European countries showing great variation. An epidemiological study performed in Cape Town from 1990 to 1995 demonstrated an incidence of melanoma of 24.4 per 100 000 white people per annum. We conducted a methodologically identical study in the same geographical area after a 10-year interval, to identify whether there is a trend in the incidence of melanoma in this area

Individualized Ranibizumab Regimen Driven by Stabilization Criteria for Central Retinal Vein Occlusion

n/

Awareness of cancer symptoms and anticipated help seeking among ethnic minority groups in England

<p>Objective: Little is known about ethnic differences in awareness of cancer-warning signs or help-seeking behaviour in Britain. As part of the National Awareness and Early Diagnosis Initiative (NAEDI), this study aimed to explore these factors as possible contributors to delay in cancer diagnosis.</p> <p>Methods: We used quota sampling to recruit 1500 men and women from the six largest minority ethnic groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). In face-to-face interviews, participants completed the newly developed cancer awareness measure (CAM), which includes questions about warning signs for cancer, speed of consultation for possible cancer symptoms and barriers to help seeking.</p> <p>Results: Awareness of warning signs was low across all ethnic groups, especially using the open-ended (recall) question format, with lowest awareness in the African group. Women identified more emotional barriers and men more practical barriers to help seeking, with considerable ethnic variation. Anticipated delay in help seeking was higher in individuals who identified fewer warning signs and more barriers.</p> <p>Conclusions: The study suggests the need for culturally sensitive, community-based interventions to raise awareness and encourage early presentation.</p&gt

Recognition of cancer warning signs and anticipated time to help-seeking in a population sample of adults in the UK

Background: Not recognising a symptom as suspicious is a common reason given by cancer patients for delayed help-seeking; but inevitably this is retrospective. We therefore investigated associations between recognition of warning signs for breast, colorectal and lung cancer and anticipated time to help-seeking for symptoms of each cancer. Methods: Computer-assisted telephone interviews were conducted with a population-representative sample (N=6965) of UK adults age greater than or equal to50 years, using the Awareness and Beliefs about Cancer scale. Anticipated time to help-seeking for persistent cough, rectal bleeding and breast changes was categorised as >2 vs less than or equal to2 weeks. Recognition of persistent cough, unexplained bleeding and unexplained lump as cancer warning signs was assessed (yes/no). Associations between recognition and help-seeking were examined for each symptom controlling for demographics and perceived ease of health-care access. Results: For each symptom, the odds of waiting for >2 weeks were significantly increased in those who did not recognise the related warning sign: breast changes: OR=2.45, 95% CI 1.47–4.08; rectal bleeding: OR=1.77, 1.36–2.30; persistent cough: OR=1.30, 1.17–1.46, independent of demographics and health-care access. Conclusion: Recognition of warning signs was associated with anticipating faster help-seeking for potential symptoms of cancer. Strategies to improve recognition are likely to facilitate earlier diagnosis

Photometric study of new southern SU UMa-type dwarf novae and candidates: V877 Ara, KK Tel and PU CMa

We photometrically observed three dwarf novae V877 Ara, KK Tel and PU CMa. We discovered undisputed presence of superhumps in V877 Ara and KK Tel, with mean periods of 0.08411(2) d and 0.08808(3) d, respectively. Both V877 Ara and KK Tel are confirmed to belong to long-period SU UMa-type dwarf novae. In V877 Ara, we found a large decrease of the superhump period (dot(P)/P = -14.5 +/- 2.1 x 10^(-5)). There is evidence that the period of KK Tel decreased at a similar or a more exceptional rate. Coupled with the past studies of superhump period changes, these findings suggest that a previously neglected diversity of phenomena is present in long-period SU UMa-type dwarf novae. The present discovery of a diversity in long-period SU UMa-type systems would become an additional step toward a full understanding the dwarf nova phenomenon. PU CMa is shown to be an excellent candidate for an SU UMa-type dwarf nova. We examined the outburst properties of these dwarf novae, and derived characteristic outburst recurrence times. Combined with the recently published measurement of the orbital period of PU CMa, we propose that PU CMa is the first object filling the gap between the extreme WZ Sge-type and ER UMa-type stars.Comment: 12 pages, 14 figures, accepted for publication in MNRA

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma

Risk factors for delay in symptomatic presentation: a survey of cancer patients

Background: Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers. Methods: We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group. Results: Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor’s time were also strong risk factors for delay, but were much less commonly reported (<6%). Interpretation: Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised

The 2006 November outburst of EG Aquarii: the SU UMa nature revealed

We report time-resolved CCD photometry of the cataclysmic variable EG Aquarii during the 2006 November outburst During the outburst, superhumps were unambiguously detected with a mean period of 0.078828(6) days, firstly classifying the object as an SU UMa-type dwarf nova. It also turned out that the outburst contained a precursor. At the end of the precursor, immature profiles of humps were observed. By a phase analysis of these humps, we interpreted the features as superhumps. This is the second example that the superhumps were shown during a precursor. Near the maximum stage of the outburst, we discovered an abrupt shift of the superhump period by ${\sim}$ 0.002 days. After the supermaximum, the superhump period decreased at the rate of $\dot{P}/P$=$-8.2{\times}10^{-5}$, which is typical for SU UMa-type dwarf novae. Although the outburst light curve was characteristic of SU UMa-type dwarf novae, long-term monitoring of the variable shows no outbursts over the past decade. We note on the basic properties of long period and inactive SU UMa-type dwarf novae.Comment: 9 pages, 7 figures, accepted for PAS