Early detection of cancer: knowledge and behavior among Dutch adults

Abstract

This paper reports on knowledge and behavior among Dutch adults (n=1530) regarding early detection of cancer (passive detection, active detection and help-seeking behavior). Written questionnaires assessed knowledge of detection methods and cancer symptoms, symptom recognition, detection behaviors, and help-seeking behaviors. Respondents did not have much general knowledge of detection methods and cancer symptoms, but recognized most cancer symptoms. More women than men paid attention to cancer symptoms. For most symptoms, medical help would be sought within the appropriate time by the majority of the respondents. Principal component analyses revealed relations between symptoms pertaining to the ‘interior’ body and those pertaining to the ‘exterior’ body. Correlations between symptom recognition, detection behavior and help-seeking behavior were low. Differences in demographic groups and differences in knowledge and behavior require adaptation of future health education on early detection of cancer to different groups.

Introduction

Detecting cancer in the early stages contributes to improved chances for successful treatment and thus for survival [1], [2], [3], [4]. Three categories of early detection behavior can be distinguished: (1) passive detection behavior, i.e. a person becomes aware of a cancer symptom without a conscious action; (2) active detection behavior, i.e. a conscious action to detect cancer symptoms, such as breast self-examination (BSE); (3) detection behavior by medical professionals, for instance, during a screening program or a medical check-up. Early detection of cancer is not one particular behavior, but consists of several separate behaviors. A person has to be able to recognize the different symptoms, and to know how to examine his or her body. In addition to these behaviors, a person has to visit a health care provider when a symptom is found or to participate in screening programs. Although some of these behaviors overlap, the different behaviors require different knowledge, attitudes and skills.

Most studies of early detection of cancer have focused on active detection behaviors, such as performing breast, testicular and skin self-examination, or on detection by medical health care providers, such as participating in screening programs and having yearly check-ups by a physician [5], [6], [7], [8], [9], [10], [11]. While active detection contributes to early detection of cancer, a significant contribution can also be made by passive detection and by seeking medical help promptly when potential cancer symptoms are discovered. Qin et al. [12] classify cancers in three types, to make clear which cancers can be self-detected: (1) cancers of the superficial organs, such as skin, breast and testis, which can be detected by looking for lumps, ulcerations or moles or by palpation; (2) cancers of the hollow organs, such as urinary bladder, lungs, etc. which can be detected by being alert on, for instance, blood loss; (3) cancer of deep, solid organs, which does not give any signals in the early development of the cancer and which cannot be detected by palpation.

Few studies have focused on the performance of passive detection behaviors. Knowledge of cancer symptoms is a prerequisite for correct interpretation of symptoms and is associated with help-seeking behavior [13], [14], [15], [16]. One study found that Dutch adults knew little about cancer symptoms and detection methods [17]. Moreover, the Dutch study showed there were differences regarding knowledge of cancer symptoms, knowledge of detection methods and passive detection behavior between sexes, age groups, and educational level groups. Compared to men, women had greater knowledge of cancer symptoms and detection methods, and checked themselves more often for cancer symptoms. Knowledge of cancer symptoms can be measured by asking open-ended questions about what cancer symptoms are, or in retrospective studies by asking with closed-ended questions whether the subjects had interpreted symptoms they had experienced as cancer symptoms. A limitation of the first method is that it is not always necessary to be able to actively recall symptoms, since recognition might be sufficient for associating symptoms with a serious health problem and thus seeking help. The second method might be limited by social desirability, resulting in an over-estimation of knowledge.

The aim of the present paper is to assess to what extent Dutch adults recognized cancer symptoms, participated in detection methods (passive detection) and sought medical help for possible cancer symptoms. This study furthermore aimed at determining differences in knowledge and behavior in relation to demographic variables. Furthermore, we analyzed the underlying factors linking cancer symptoms in order to indicate different components related to recognizing symptoms, passive detection and help-seeking behavior, and to assess the relationship between symptom recognition, passive detection and help-seeking.