Prevalence of beliefs about actual and mythical causes of cancer and their association with socio-demographic and health-related characteristics: findings from a cross-sectional survey in England

Background: Literature on population awareness about actual causes of cancer is growing but comparatively little is known about the prevalence of people’s belief concerning mythical causes of cancer. This study aimed to estimate the prevalence of these beliefs and their association with socio-demographic characteristics and health behaviours. Methods: A survey containing validated measures of beliefs about actual and mythical cancer causes and health behaviours (smoking, alcohol consumption, physical activity, fruit and vegetable consumption, overweight) was administered to a representative English population sample (N=1,330). Results: Awareness of actual causes of cancer (52% accurately identified; 95% Confidence Interval (CI) 51-54) was greater than awareness of mythical cancer causes (36% accurately identified; 95%CI 34-37; P<0.01). The most commonly endorsed mythical cancer causes were exposure to stress (43%; 95%CI 40-45), food additives (42%; 95%CI 39-44) and electromagnetic frequencies (35%; 95%CI 33-38). In adjusted analysis, greater awareness of actual and mythical cancer causes was independently associated with younger age, higher social grade, being white and having post-16 qualifications. Awareness of actual but not mythical cancer causes was associated with not smoking and eating sufficient fruit and vegetables. Conclusions: Awareness of actual and mythical cancer causes is poor in the general population. Only knowledge of established risk factors is associated with adherence to behavioural recommendations for reducing cancer risk

Acceptability of receiving lifestyle advice at cervical, breast and bowel cancer screening

Cancer screening could be an opportunity to deliver cancer prevention advice, but it is not known how such information would be received. We explored willingness to receive lifestyle advice in the context of the English National Health Service cervical, breast, and bowel (FS; flexible sigmoidoscopy) screening programmes. A population-based survey was conducted in 2016 to collect nationally representative data on willingness to receive lifestyle advice across cervical (n = 768), breast (n = 420) and FS (n = 308) screening programmes. Additional items assessed the impact of lifestyle advice on screening attendance, preference for receiving advice in the event of an abnormal screening result, and timing of advice. Most respondents were willing to receive lifestyle advice around the time of cancer screening (cervical 78.9%, breast 79.4%, FS 81.8%), and if their results were abnormal (cervical 86.3%, breast 83.0%, FS 85.1%). A small proportion indicated it may discourage future attendance (cervical 4.9%, breast 7.0%, FS 8.8%). Most preferred information to be delivered at the screening appointment (cervical 69.8%, breast 72.6%, FS 70.7%). There were no associations between sociodemographic characteristics and willingness to receive lifestyle advice at breast screening. For those intending to attend cervical screening, non-White ethnicity and higher education were associated with increased willingness to receive lifestyle advice. Women were more likely to be willing to receive advice at FS screening than men. Providing lifestyle advice at cancer screening is likely to be acceptable to the general population. The optimal approach for delivery needs careful consideration to minimise potential negative effects on screening attendance

Interest in lifestyle advice at lung cancer screening: Determinants and preferences

Background Lung cancer screening could be a ‘teachable moment’ for behaviour change. Little is known about how advice about smoking cessation, or other behavioural cancer risk factors, would be received in this setting. Methods Using a population-based survey of 459 English adults (current smokers and recent quitters aged 50–75) we assessed willingness to receive lifestyle advice (about smoking, diet, weight, physical activity, alcohol consumption) at lung screening. Additional items assessed whether advice should be provided following abnormal screening results, the potential impact of advice on screening uptake, and preferred timing of advice. Results Overall, 64% (n = 292) of participants were willing to receive lifestyle advice at lung screening. A greater proportion of participants were willing to receive advice in a scenario where results required further investigation (83%; p < 0.01). However, 14% indicated the provision of lifestyle advice would make them less willing to attend lung screening. Non-White ethnicity and greater cancer risk factor awareness were associated with willingness to receive advice (p < 0.05). Half of smokers (51%) were willing to receive cessation advice. There was also interest in advice about diet (47%), weight (43%), physical activity (32%), and alcohol consumption (17%) among people not meeting current recommendations for these behaviours. There was a preference for advice to be delivered at the screening appointment (38%, n = 108) over other time-points. Conclusions Lung screening may offer an opportunity to provide advice about behavioural cancer risk factors. Future work should consider how to deliver effective interventions in this setting to support behaviour change, without affecting screening uptake

Interest in lifestyle advice at lung cancer screening: Determinants and preferences

Background Lung cancer screening could be a ‘teachable moment’ for behaviour change. Little is known about how advice about smoking cessation, or other behavioural cancer risk factors, would be received in this setting. Methods Using a population-based survey of 459 English adults (current smokers and recent quitters aged 50–75) we assessed willingness to receive lifestyle advice (about smoking, diet, weight, physical activity, alcohol consumption) at lung screening. Additional items assessed whether advice should be provided following abnormal screening results, the potential impact of advice on screening uptake, and preferred timing of advice. Results Overall, 64% (n = 292) of participants were willing to receive lifestyle advice at lung screening. A greater proportion of participants were willing to receive advice in a scenario where results required further investigation (83%; p < 0.01). However, 14% indicated the provision of lifestyle advice would make them less willing to attend lung screening. Non-White ethnicity and greater cancer risk factor awareness were associated with willingness to receive advice (p < 0.05). Half of smokers (51%) were willing to receive cessation advice. There was also interest in advice about diet (47%), weight (43%), physical activity (32%), and alcohol consumption (17%) among people not meeting current recommendations for these behaviours. There was a preference for advice to be delivered at the screening appointment (38%, n = 108) over other time-points. Conclusions Lung screening may offer an opportunity to provide advice about behavioural cancer risk factors. Future work should consider how to deliver effective interventions in this setting to support behaviour change, without affecting screening uptake

The development of a tool to assess beliefs about mythical causes of cancer: the Cancer Awareness Measure Mythical Causes Scale

Objectives: We aimed to develop a reliable and valid measure to assess public beliefs in mythical causes of cancer: the Cancer Awareness Measure - MYthical Causes Scale (CAM-MYCS). Design and setting: Cancer myth items were generated from a literature review, social media and interviews (n=16). The CAM-MYCS was prepared by reducing items using a) an online sample (n=527) with exploratory factor analysis and b) cancer experts with DELPHI methodology (n=13). To assess test-retest reliability and sensitivity to change, students (n=91) completed the CAM-MYCS at baseline and 1-week after exposure to information on lifestyle-related cancer causes or control information. Construct validity was tested by comparing CAM-MYCS scores between cancer experts (n=25) and students (n=91). Factor structure and internal reliability were investigated in a national sample (n=1993). Results: Out of 42 items generated, 12 were retained based on factor loadings, prevalence of endorsement, and expert consensus. CAM-MYCS scores improved (fewer myths endorsed) among students exposed to information on cancer causes compared with the control group (p<0.001) and showed high test–retest reliability (r=0.90, p<0.001). Cancer experts reported higher CAM-MYCS scores (fewer myths endorsed) than students (p<0.001). The factor structure of the CAM-MYCS was confirmed in the national sample and internal reliability was high (α=0.86). Inclusion of the CAM-MYCS alongside items assessing knowledge of actual cancer causes did not affect responses. Conclusions: The CAM-MYCS tool is a reliable and valid tool assessing beliefs in mythical causes of cancer, and it can be used alongside items assessing known causes of cancer

Predictors of the experience of a Cytosponge test: analysis of patient survey data from the BEST3 trial

Background The Cytosponge is a cell-collection device, which, coupled with a test for trefoil factor 3 (TFF3), can be used to diagnose Barrett’s oesophagus, a precursor condition to oesophageal adenocarcinoma. BEST3, a large pragmatic, randomised, controlled trial, investigated whether offering the Cytosponge-TFF3 test would increase detection of Barrett’s. Overall, participants reported mostly positive experiences. This study reports the factors associated with the least positive experience. Methods Patient experience was assessed using the Inventory to Assess Patient Satisfaction (IAPS), a 22-item questionnaire, completed 7–14 days after the Cytosponge test. Study cohort All BEST3 participants who answered ≥ 15 items of the IAPS (N = 1458). Statistical analysis A mean IAPS score between 1 and 5 (5 indicates most negative experience) was calculated for each individual. ‘Least positive’ experience was defined according to the 90th percentile. 167 (11.4%) individuals with a mean IAPS score of ≥ 2.32 were included in the ‘least positive’ category and compared with the rest of the cohort. Eleven patient characteristics and one procedure-specific factor were assessed as potential predictors of the least positive experience. Multivariable logistic regression analysis using backwards selection was conducted to identify factors independently associated with the least positive experience and with failed swallow at first attempt, one of the strongest predictors of least positive experience. Results The majority of responders had a positive experience, with an overall median IAPS score of 1.7 (IQR 1.5–2.1). High (OR = 3.01, 95% CI 2.03–4.46, p < 0.001) or very high (OR = 4.56, 95% CI 2.71–7.66, p < 0.001) anxiety (relative to low/normal anxiety) and a failed swallow at the first attempt (OR = 3.37, 95% CI 2.14–5.30, p < 0.001) were highly significant predictors of the least positive patient experience in multivariable analyses. Additionally, sex (p = 0.036), height (p = 0.032), alcohol intake (p = 0.011) and education level (p = 0.036) were identified as statistically significant predictors. Conclusion We have identified factors which predict patient experience. Identifying anxiety ahead of the procedure and discussing particular concerns with patients or giving them tips to help with swallowing the capsule might help improve their experience. Trial registration ISRCTN68382401

What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?

The bone disease that occurs as a result of chronic kidney disease (CKD) is not only debilitating but also linked to poor growth and cardiovascular disease. It is suspected that abnormal bone turnover is the main culprit for these poor outcomes. Plasma parathyroid hormone (PTH) levels are used as a surrogate marker of bone turnover, and there is a small number of studies in children that have attempted to identify the range of PTH levels that correlates with normal bone histology. It is clear that high PTH levels are associated with high bone turnover, although the range is wide. However, the ability of PTH levels to distinguish between low and normal bone turnover is less clear. This is an important issue, because current guidelines for calcium and phosphate management are based upon there being an “optimum” range for PTH. This editorial takes a critical look at the evidence upon which these recommendations are based

Methods for evaluating clustering algorithms for gene expression data using a reference set of functional classes

BACKGROUND: A cluster analysis is the most commonly performed procedure (often regarded as a first step) on a set of gene expression profiles. In most cases, a post hoc analysis is done to see if the genes in the same clusters can be functionally correlated. While past successes of such analyses have often been reported in a number of microarray studies (most of which used the standard hierarchical clustering, UPGMA, with one minus the Pearson's correlation coefficient as a measure of dissimilarity), often times such groupings could be misleading. More importantly, a systematic evaluation of the entire set of clusters produced by such unsupervised procedures is necessary since they also contain genes that are seemingly unrelated or may have more than one common function. Here we quantify the performance of a given unsupervised clustering algorithm applied to a given microarray study in terms of its ability to produce biologically meaningful clusters using a reference set of functional classes. Such a reference set may come from prior biological knowledge specific to a microarray study or may be formed using the growing databases of gene ontologies (GO) for the annotated genes of the relevant species. RESULTS: In this paper, we introduce two performance measures for evaluating the results of a clustering algorithm in its ability to produce biologically meaningful clusters. The first measure is a biological homogeneity index (BHI). As the name suggests, it is a measure of how biologically homogeneous the clusters are. This can be used to quantify the performance of a given clustering algorithm such as UPGMA in grouping genes for a particular data set and also for comparing the performance of a number of competing clustering algorithms applied to the same data set. The second performance measure is called a biological stability index (BSI). For a given clustering algorithm and an expression data set, it measures the consistency of the clustering algorithm's ability to produce biologically meaningful clusters when applied repeatedly to similar data sets. A good clustering algorithm should have high BHI and moderate to high BSI. We evaluated the performance of ten well known clustering algorithms on two gene expression data sets and identified the optimal algorithm in each case. The first data set deals with SAGE profiles of differentially expressed tags between normal and ductal carcinoma in situ samples of breast cancer patients. The second data set contains the expression profiles over time of positively expressed genes (ORF's) during sporulation of budding yeast. Two separate choices of the functional classes were used for this data set and the results were compared for consistency. CONCLUSION: Functional information of annotated genes available from various GO databases mined using ontology tools can be used to systematically judge the results of an unsupervised clustering algorithm as applied to a gene expression data set in clustering genes. This information could be used to select the right algorithm from a class of clustering algorithms for the given data set

The effect of a supplementary ('Gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial.

Guided by Fuzzy Trace Theory, this study examined the impact of a 'Gist-based' leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants' numerical ability. Adults aged 45-59 years from four UK general practices were randomly assigned to receive standard information ('The Facts', n = 2,216) versus standard information plus 'The Gist' leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The 'Gist + Facts' group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest 'The Gist' leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected