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

Outbursts of EX Hydrae: mass-transfer events or disc instabilities?

We present the 45-yr record of the light curve of EX Hya, and discuss the characteristics of its 15 observed outbursts. We then concentrate on the 1998 outburst, reporting the first outburst X-ray observations. We discover an X-ray beat-cycle modulation, indicating that an enhanced accretion stream couples directly with the magnetosphere in outburst, confirming our previous prediction. Optical eclipse profiles late in outburst show that the visible light is dominated by an enhanced mass-transfer stream overflowing the accretion disc. We are uncertain whether the enhanced mass transfer is triggered by a disc instability, or by some other cause. While in outburst, EX Hya shows some of the characteristics of SW Sex stars

X-Ray Observations of V4641 SGR (= SAX J1819.3-2525) During the Brief and Violent Outburst of 2003

We present the results of detailed analysis of pointed X-ray observations by RXTE PCA/HEXTE of the black hole X-ray binary (BHXRB) system V4641 Sgr (= SAX J1819.3-2525) during its outburst of August 2003. Soft X-ray (3-20 keV) flux variations by factors of 10 or more on timescales of minutes or shorter were seen. The rapid and strong variability of this source sets it apart from typical XRBs. In spite of large luminosity fluctuations, the spectral state of the source did not change significantly during the dwells which suggests that the physical emission processes did not change much during the observations. The energy spectra during the dwells were dominated by a hard Comptonized powerlaw component, indicative of the canonical low/hard state observed in other BHXRBs. No soft thermal component was found in three out of the four RXTE pointings. However spectral deconvolution of the observation with largest average luminosity suggests an obscured, hot accretion disk. During one of the observations we detected a short term (about 100s) soft X-ray dropout which is apparently due to variability in the observed column density. Strong Fe K$\alpha$ fluorescent emisssion line near 6.5 keV was detected with large equivalent widths in the range of 700 - 1000eV. In the temporal domain, the Fourier power spectra were dominated by red noise below a few Hz. Poisson noise dominated at higher frequencies and no high frequency features were detected. The strong Comptonized spectra, broad iron emission line, absence of disk component in the spectra, absence of any timing variability above few Hz and occasional large changes in the column density along the line-of-sight, all support an enshrouded black hole with occasional outflow and a very dynamic environment.Comment: 27 pages, 10 figures (1 color figure), accepted for publication in the Astrophysical Journal. It is tentatively scheduled for the ApJ 01 February 2006, v637, 2 issu

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

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

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

&lt;p&gt;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.&lt;/p&gt; &lt;p&gt;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.&lt;/p&gt; &lt;p&gt;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.&lt;/p&gt; &lt;p&gt;Conclusions: The study suggests the need for culturally sensitive, community-based interventions to raise awareness and encourage early presentation.&lt;/p&gt

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

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

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Cancer symptom awareness and barriers to symptomatic presentation in England – Are we clear on cancer?

Background: Low cancer awareness may contribute to delayed diagnosis and poor cancer survival. We aimed to quantify socio-demographic differences in cancer symptom awareness and barriers to symptomatic presentation in the English population. Methods: Using a uniquely large data set (n=49?270), we examined the association of cancer symptom awareness and barriers to presentation with age, gender, marital status and socio-economic position (SEP), using logistic regression models to control for confounders. Results: The youngest and oldest, the single and participants with the lowest SEP recognised the fewest cancer symptoms, and reported most barriers to presentation. Recognition of nine common cancer symptoms was significantly lower, and embarrassment, fear and difficulties in arranging transport to the doctor’s surgery were significantly more common in participants living in the most deprived areas than in the most affluent areas. Women were significantly more likely than men to both recognise common cancer symptoms and to report barriers. Women were much more likely compared with men to report that fear would put them off from going to the doctor. Conclusions: Large and robust socio-demographic differences in recognition of some cancer symptoms, and perception of some barriers to presentation, highlight the need for targeted campaigns to encourage early presentation and improve cancer outcomes