title: Is cancer survival associated with cancer symptom awareness and barriers to seeking medical help in England? An ecological study.
abstract: Campaigns aimed at raising cancer awareness and encouraging early presentation have been implemented in England. However, little is known about whether people with low cancer awareness and increased barriers to seeking medical help have worse cancer survival, and whether there is a geographical variation in cancer awareness and barriers in England.
  
  
  
  From population-based surveys (n=35 308), using the Cancer Research UK Cancer Awareness Measure, we calculated the age- and sex-standardised symptom awareness and barriers scores for 52 primary care trusts (PCTs). These measures were evaluated in relation to the sex-, age-, and type of cancer-standardised cancer survival index of the corresponding PCT, from the National Cancer Registry, using linear regression. Breast, lung, and bowel cancer survival were analysed separately.
  
  
  
  Cancer symptom awareness and barriers scores varied greatly between geographical regions in England, with the worst scores observed in socioeconomically deprived parts of East London. Low cancer awareness score was associated with poor cancer survival at PCT level (estimated slope=1.56, 95% CI: 0.56; 2.57). The barriers score was not associated with overall cancer survival, but it was associated with breast cancer survival (estimated slope=-0.66, 95% CI: -1.20; -0.11). Specific barriers, such as embarrassment and difficulties in arranging transport to the doctor's surgery, were associated with worse breast cancer survival.
  
  
  
  Cancer symptom awareness and cancer survival are associated. Campaigns should focus on improving awareness about cancer symptoms, especially in socioeconomically deprived areas. Efforts should be made to alleviate barriers to seeking medical help in women with symptoms of breast cancer.
authors.affiliation: Cancer Epidemiology and Population Health, Cancer Studies Research Division, King's College London, Bermondsey Wing, 3rd floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Maja
authors.initials: M
authors.lastname: Niksic
authors.affiliation: Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rachet
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Duffy
authors.affiliation: Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Manuela
authors.initials: M
authors.lastname: Quaresma
authors.affiliation: Cancer Epidemiology and Population Health, Cancer Studies Research Division, King's College London, Bermondsey Wing, 3rd floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
authors.affiliation: Cancer Epidemiology and Population Health, Cancer Studies Research Division, King's College London, Bermondsey Wing, 3rd floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Lindsay Jl
authors.initials: LJ
authors.lastname: Forbes
mesh_terms: D003144:Communication Barriers; D004644:Emotions; D004739:England / Q000453:epidemiology; D005260:Female; D062306:Geography, Medical; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D011204:Poverty Areas; D011320:Primary Health Care / Q000458:organization & administration; D064890:Social Determinants of Health; D063189:Symptom Assessment