C.V.B. LA VECCHIA

E. Zuccato

G. Sermeus

M. Anelli

N. Milazzo

R. Fanelli

AIR Universita degli studi di Milano

LETTER TO THE EDITOR
Dear Sir,
Perceived risk of cancer in population samples from 5 European countries
Understanding and perceiving risks is a major issue for
any health education and preventive intervention (Zeck-
hauser and Viscusi, 1990; Hertz-Picciotto, 1995). However,
comparing risk assessment and risk perception is subject to
substantial error (Trichopoulos, 1996; La Vecchia et al.,
1999). To address these issues using a systematic and quan-
titative approach, we have conducted a survey on belief,
perception and behaviour of cancer risk in the general
population of 5 European countries: Belgium, France, Italy,
Portugal and Spain.
The study sample was selected from telephone lists in strata
of geographic area; over 95% of European households have a
telephone. During September 1998, a total of 65,000 house-
holds (13,000/country) were sent an anonymous questionnaire
(pre-tested in a pilot phase), requesting a reply by subjects
aged 16 or over (20 or over in France). A total of 5,579 valid
questionnaires was obtained (3,202 females and 2,377 males).
No reminder was sent. Only basic demographic information
was available from non-responders. The sample of respondents
over-represented women, younger age groups and subjects
with higher education. Consequently, direct standardisation
was used to correct for these factors. The questionnaire in-
cluded a general section on perception of risk of death and of
selected diseases, such as cardiovascular disease, accidents,
infectious diseases and cancer. Information was specifically
collected on perception of risk and related behaviour for 16
major recognised or potential risk factors for cancer (La
Vecchia et al., 1999). For each factor (e.g., “avoiding smok-
ing”), 3 replies were included in the questionnaire for belief
(yes, no, I do not know) and 2 for behaviour adoption (yes, no).
Table I gives the percent population perceiving (belief) or
adopting (behaviour) selected measures to reduce cancer risk,
ranked according to belief on the overall data set. Avoiding
smoking ranked first according to belief (96.8%) but third
(after reducing alcohol and limiting exposure to sunshine)
according to behaviour. The second rank according to belief,
before alcohol, was limiting exposure to sunshine (92.2%). The
fourth and fifth ranks were limiting exposure to UV radiation
and avoiding consumption of pesticide-treated vegetables and
fruit (74.4%), and a surprisingly high score was given to
extremely low-frequency electromagnetic fields (65.3%).
A smaller relevance was given to selected nutritional and
dietary factors, such as avoiding overweight (59.1%) or exces-
sive calorie intake (51.6%), which was believed to be as
important as avoiding genetically modified foods (51.2%).
Other measures with no documented impact of cancer risk also
showed appreciable proportions of belief, including avoiding
using cellular phones (39.6%), avoiding microwaved foods
(34.3%) and using food supplements (29.4%). These were also
the factors with generally larger between-country variation
(e.g., between 57.8% in Italy and 26.3% in France for cellular
phones), in the absence, however, of any single and consistent
pattern (La Vecchia et al., 1999).
With reference to behaviour adopted, 64.1% of respondents
reported limiting alcohol drinking, 61.5% limiting exposure to
sunshine and 60.9% avoiding smoking. Most other items
ranged between 30% and 45%. Between-country variation
was, if anything, larger for several behaviours than for beliefs.
The sample was large enough to provide reliable estimates
for most factors considered but over-sampled women, younger
age groups and more educated subjects. These potential
sources of bias were corrected by direct standardisation, but
some residual bias is possible. A non-quantifiable bias, more-
over, may have been introduced by the low response rate,
which is inherent in the study design.
In conclusion, tobacco and alcohol, the 2 major determi-
nants of cancer on a population level in Europe, were per-
ceived to be major risk factors (Sutton, 1998; Doll, 1999),
though consequent behaviours were adopted by only about
60% of the population. Sunshine exposure is a well-defined but
quantitatively smaller cancer risk factor on a population level,
but was perceived to be a risk factor by most subjects (English
et al., 1997). Other sources of non-ionizing radiation, such as
electromagnetic fields, whose role in cancer occurrence, if any,
remains largely undefined (Poole and Trichopoulos, 1991;
Trichopoulos, 1996; Doll, 1999), appeared to be grossly over-
estimated. Most nutritional and dietary factors ranked rela-
tively low as risk factors for cancer, including some of the best
established ones (i.e., overweight), whereas the role of food
colouring, other food additives or pesticides was largely over-
estimated (Ames et al., 1995), thus confirming the uncertainties
and difficulties in the process of cancer risk communication
and perception (Fischhoff, 1999; Gerrard et al., 1999).
Yours sincerely,
Carlo LA VECCHIA1,2*, Marco ANELLI3, Ettore ZUCCATO1,
Roberto FANELLI1, Guy SERMEUS4 and Natalia MILAZZO3
1Istituto di Ricerche Farmacologiche “Mario Negri”, Milan,
Italy
2Istituto di Statistica Medica e Biometria, Universita` degli
Studi di Milano, Milan, Italy
3Comitato Consumatori Altroconsumo-Conseur, Milan, Italy
4Test Achats-Conseur, Brussels, Belgium
Grant sponsors: Comitato Consumatori Altroconsumo-Conseur; Italian
Association for Cancer Research.
*Correspondence to: Istituto di Ricerche Farmacologiche “Mario Ne-
gri”, Via Eritrea 62, I-20157 Milan, Italy. Fax: 139-02-354 62 77.
Received 14 September 1999; Revised 1 December 1999
Int. J. Cancer: 86, 747–748 (2000)
© 2000 Wiley-Liss, Inc.
Publication of the International Union Against Cancer
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TABLE I – PERCENT POPULATION PERCEIVING (BELIEF) OR ADOPTING (BEHAVIOUR) SELECTED MEASURES TO REDUCE CANCER RISK IN 5 EUROPEAN
COUNTRIES (BELGIUM, FRANCE, ITALY, PORTUGAL, SPAIN), 1998
Measure
Total sample Belgium France Italy Portugal Spain
Belief Behaviour Belief
%
Behaviour
%
Belief
%
Behaviour
%
Belief
%
Behaviour
%
Belief
%
Behaviour
%
Belief
%
Behaviour
%Rank % Rank %
Avoiding smoking 1 96.8 3 60.9 97.5 69.3 97.8 66.1 96.4 59.1 90.0 70.4 97.4 52.3
Limiting exposure
to sunshine
2 92.2 2 61.5 94.3 67.1 95.7 70.5 88.0 53.0 83.6 67.4 95.4 59.6
Reducing alcohol
drinking
3 84.0 1 64.1 75.8 61.9 84.0 67.2 86.7 63.6 83.5 69.3 82.0 60.2
Limiting exposure
to UV
4 83.2 4 58.7 89.0 67.6 88.2 69.8 78.9 53.7 64.5 50.2 85.7 51.5
Avoiding
pesticide-treated
fruit and
vegetables
5 74.4 8 36.0 78.4 42.2 66.2 37.0 82.6 39.0 64.5 42.3 73.8 27.2
Limiting
consumption of
food colouring
6 72.9 5 44.8 73.0 46.6 57.6 38.0 84.9 53.5 77.6 54.5 73.7 38.2
Avoiding
exposure to
electromagnetic
fields
7 65.3 8 36.0 56.7 31.5 51.2 31.9 74.9 41.3 54.9 36.1 73.5 34.7
Reducing grilled/
smoked food
consumption
8 62.3 6 41.8 87.3 64.5 73.5 52.3 65.6 43.3 39.5 28.6 41.4 23.2
Avoiding
overweight
9 59.1 — — 64.2 — 53.9 — 61.2 — 63.5 — 60.7 —
Avoiding
excessive
calorie intake
10 51.6 10 35.7 60.8 45.9 52.3 40.9 49.1 34.6 56.4 42.4 50.8 26.6
Avoiding
genetically
modified food
11 51.2 11 34.0 34.4 25.5 47.6 35.8 58.6 40.0 58.9 36.8 48.0 24.4
Eating whole-meal
products
12 50.3 12 30.7 69.3 53.5 40.7 27.6 55.8 29.8 57.5 42.4 48.3 27.5
Reducing red
meat
consumption
13 48.2 7 37.3 50.4 42.0 40.9 34.3 59.7 42.6 51.2 35.4 39.0 32.6
Avoiding using
mobile phones
14 39.6 14 22.8 36.2 23.7 26.3 18.3 57.8 31.2 33.4 21.9 32.0 16.1
Avoiding
microwaved
foods
15 34.3 13 28.4 27.8 24.3 27.7 24.0 36.0 29.3 44.5 39.5 40.0 31.4
Using food
supplements
16 29.4 15 17.4 29.6 19.3 26.8 18.2 33.8 17.3 41.8 23.4 23.4 14.8
748 LA VECCHIA ET AL.


Perceived risk of cancer in population samples from 5 european countries

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Perceived risk of cancer in population samples from 5 european countries

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