title: Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United kingdom.
abstract: BACKGROUND
  Qualitative studies implicate knowledge of cancer symptoms and attitudes towards help-seeking as important factors in patient delay. The present study uses quantitative data from a population-based survey to test the hypotheses that (a) a greater knowledge of early cancer symptoms is associated with a higher likelihood of having appraised a symptom as possibly due to cancer, and (b) more negative attitudes towards help-seeking are associated with a lower likelihood of having sought medical advice for that symptom.
  
  
  METHODS
  Two thousand and seventy-one adults were asked whether they had experienced a symptom that they worried might be cancer in the past 3 months, and if so, whether they had seen a doctor. Respondents also completed the Cancer Awareness Measure (CAM) assessing symptom knowledge and barriers to help-seeking.
  
  
  RESULTS
  Two hundred and thirty-six (11.4%) respondents reported having experienced a possible cancer symptom. In logistic regression analyses controlling for age, sex, and self-rated health, higher CAM symptom knowledge scores were associated with a greater likelihood of having experienced a possible cancer symptom (odds ratio = 1.09; 95% confidence interval, 1.01-1.17). Of those who had experienced a symptom, 75% (177/236) had seen a doctor. Higher scores on the CAM barriers scale were associated with being less likely to have seen a doctor (odds ratio, 0.74; 95% confidence interval, 0.63-0.87).
  
  
  CONCLUSIONS
  Better knowledge of the signs and symptoms of cancer might help people recognize possible cancer symptoms and therefore reduce appraisal delay, whereas more positive attitudes towards help-seeking might reduce behavioral delay.
  
  
  CONCLUSIONS
  Campaigns to educate the public about cancer symptoms and reduce help-seeking barriers could play a role in promoting early diagnosis.
authors.affiliation: Department of Epidemiology and Public Health, University College London, Cancer Research UK Health Behaviour Research Centre, London, United Kingdom. alice.simon@ucl.ac.uk
authors.forename: Alice E
authors.initials: AE
authors.lastname: Simon
authors.forename: Jo
authors.initials: J
authors.lastname: Waller
authors.forename: Kathryn
authors.initials: K
authors.lastname: Robb
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D001294:Attitude to Health; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology