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Educational differences in likelihood of attributing breast symptoms to cancer: A vignette-based study

Marcu, A; Lyratzopoulos, G; Black, G; Vedsted, P; Whitaker, KL; (2016) Educational differences in likelihood of attributing breast symptoms to cancer: A vignette-based study. Psycho-Oncology , 25 (10) pp. 1191-1197. 10.1002/pon.4177. Green open access

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Abstract

BACKGROUND: Stage at diagnosis of breast cancer varies by socio-economic status (SES), with lower SES associated with poorer survival. We investigated associations between SES (indexed by education), and the likelihood of attributing breast symptoms to breast cancer. METHOD: We conducted an online survey with 961 women (47-92 years) with variable educational levels. Two vignettes depicted familiar and unfamiliar breast changes (axillary lump and nipple rash). Without making breast cancer explicit, women were asked 'What do you think this […..] could be?' After the attribution question, women were asked to indicate their level of agreement with a cancer avoidance statement ('I would not want to know if I have breast cancer'). RESULTS: Women were more likely to mention cancer as a possible cause of an axillary lump (64%) compared with nipple rash (30%). In multivariable analysis, low and mid education were independently associated with being less likely to attribute a nipple rash to cancer (OR 0.51, 0.36-0.73 and OR 0.55, 0.40-0.77, respectively). For axillary lump, low education was associated with lower likelihood of mentioning cancer as a possible cause (OR 0.58, 0.41-0.83). Although cancer avoidance was also associated with lower education, the association between education and lower likelihood of making a cancer attribution was independent. CONCLUSION: Lower education was associated with lower likelihood of making cancer attributions for both symptoms, also after adjustment for cancer avoidance. Lower likelihood of considering cancer may delay symptomatic presentation and contribute to educational differences in stage at diagnosis.

Type: Article
Title: Educational differences in likelihood of attributing breast symptoms to cancer: A vignette-based study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/pon.4177
Publisher version: http://dx.doi.org/10.1002/pon.4177
Language: English
Additional information: Copyright © 2016 John Wiley & Sons, Ltd. All rights reserved. This is the peer reviewed version of the following Marcu, A; Lyratzopoulos, G; Black, G; Vedsted, P; Whitaker, KL; (2016) Educational differences in likelihood of attributing breast symptoms to cancer: A vignette-based study. Psycho-Oncologywhich has been published in final form at 10.1002/pon.4177. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving, http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms
Keywords: Cancer, Early diagnosis, Education, Inequalities, Oncology, Symptom attribution
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
URI: https://discovery.ucl.ac.uk/id/eprint/1496046
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