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Eur J Cancer Prev. 2015 May;24(3):253-60. doi: 10.1097/CEJ.0000000000000140.

Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study.

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aHealth Behaviour Research Centre, Department of Epidemiology and Public Health, University College London bHealth Services Research, School of Health Sciences, City University London cKing's College London Promoting Early Presentation Group, King's College London, London dInstitute of Health and Wellbeing, University of Glasgow, Glasgow eCochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff fNorthern Ireland Cancer Registry Centre for Public Health, Queen's University Belfast, Belfast, UK.


Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, ageā‰„50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. 'Cancer can often be cured') and three negatively framed (e.g. 'A cancer diagnosis is a death sentence'). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that 'treatment is worse than cancer', 27% that cancer is 'a death sentence' and 16% 'would not want to know if I have cancer'. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.

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