The structure and demographic correlates of cancer fear

BMC Cancer

Charlotte Vrinten²  Cornelia H M van Jaarsveld¹  Jo Waller²  Christian von Wagner²  Jane Wardle² 

[1] Department of Primary Care and Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London SE1 3QD, UK

[2] Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, UK

关键词: Older adults;    STAI;    Gender;    Ethnicity;    Education;    Anxiety;    Cancer worry;    Cancer fear;   

Others  :  1125193
DOI  :  10.1186/1471-2407-14-597

 received in 2014-04-02, accepted in 2014-08-08,  发布年份 2014

【 摘 要 】

Background

Cancer is often described as the ‘number one’ health fear, but little is known about whether this affects quality of life by translating into high levels of worry or distress in everyday life, or which population groups are most affected. This study examined the prevalence of three components of cancer fear in a large community sample in the UK and explored associations with demographic characteristics.

Methods

Questions on cancer fear were included in a survey mailed to a community sample of adults (n = 13,351; 55–64 years). Three items from a standard measure of cancer fear assessed: i) whether cancer was feared more than other diseases, ii) whether thinking about cancer caused discomfort, and iii) whether cancer worry was experienced frequently. Gender, marital status, education, and ethnicity were assessed with simple questions. Anxiety was assessed with the brief STAI and a standard measure of self-rated health was included.

Results

Questionnaire return rate was 60% (7,971/13,351). The majority of respondents agreed or strongly agreed that they feared cancer more than other diseases (59%), and felt uncomfortable thinking about it (52%), and a quarter (25%) worried a lot about cancer. All items were significantly inter-correlated (r = .35 to .42, p’s < .001), and correlated with general anxiety (r = .16 to .28, p’s < .001) and self-rated health (r = -.07 to -.16, p’s < .001). In multivariable analyses including anxiety and general health, all cancer fear indicators were significantly higher in women (ORs between 1.15 and 1.48), respondents with lower education (ORs between 1.40 and 1.66), and those with higher general anxiety (ORs between 1.50 and 2.11). Ethnic minority respondents (n = 285; 4.4%) reported more worry (OR: 1.85).

Conclusions

More than half of this older adult sample in the UK had cancer as greatest health fear and this was associated with feeling uncomfortable thinking about it and worrying more about it. Women and respondents with less education or from ethnic minority backgrounds were disproportionately affected by cancer fear. General anxiety and poor health were associated with cancer fear but did not explain the demographic differences.

【 授权许可】

   
2014 Vrinten et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Toon E: “Cancer as the general population knows it”: knowledge, fear, and lay education in 1950s Britain. Bull Hist Med 2007, 81(1):116-138.
• [2]Law M: Screening without evidence of efficacy: screening of unproved value should not be advocated. BMJ 2004, 328(7435):301.
• [3]Barker A, Jordan H: Public Attitudes Concerning Cancer. In Holland-Frei Cancer Medicine. 6th edition. Edited by Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, Frei E3rd. Hamilton (ON): BC Decker; 2003.
• [4]Eisinger F, Moatti JP, Beja V, Obadia Y, Alias F, Dressen C: Attitude of the French female population to cancer screening. Bull Cancer 1994, 81(8):683-690.
• [5]Cancer Research UK: People fear cancer more than other serious illness. [http://www.cancerresearchuk.org/about-us/cancer-news/press-release/people-fear-cancer-more-than-other-serious-illness webcite]
• [6]Cancer Research UK: Cancer is biggest fear but 34 per cent put it down to fate. [http://www.cancerresearchuk.org/about-us/cancer-news/press-release/cancer-is-biggest-fear-but-34-per-cent-put-it-down-to-fate webcite]
• [7]Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI: Fear, anxiety, worry, and breast cancer screening behavior: a critical review. Cancer Epidemiol Biomarkers Prev 2004, 13(4):501-510.
• [8]Hay JL, Buckley TR, Ostroff JS: The role of cancer worry in cancer screening: a theoretical and empirical review of the literature. Psychooncology 2005, 14(7):517-534.
• [9]Dubayova T, van Dijk JP, Nagyova I, Rosenberger J, Havlikova E, Gdovinova Z, Middel B, Groothoff JW: The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review. Int J Public Health 2010, 55(5):459-468.
• [10]Miles A, Voorwinden S, Chapman S, Wardle J: Psychologic predictors of cancer information avoidance among older adults: the role of cancer fear and fatalism. Cancer Epidemiol Biomarkers Prev 2008, 17(8):1872-1879.
• [11]Taha H, Al-Qutob R, Nyström L, Wahlström R, Berggren V: “Voices of fear and safety” women's ambivalence towards breast cancer and breast health: a qualitative study from Jordan. BMC Womens Health 2012, 12:21.
• [12]Jensen JD, Bernat JK, Davis LA, Yale R: Dispositional cancer worry: convergent, divergent, and predictive validity of existing scales. J Psychosoc Oncol 2010, 28(5):470-489.
• [13]McCaul KD, Branstetter AD, O’Donnell SM, Jacobson K, Quinlan KB: A descriptive study of breast cancer worry. J Behav Med 1998, 21(6):565-579.
• [14]Hay JL, McCaul KD, Magnan RE: Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Prev Med 2006, 42(6):401-408.
• [15]Consedine NS, Adjei BA, Ramirez PM, McKiernan JM: An object lesson: Source determines the relations that trait anxiety, prostate cancer worry, and screening fear hold with prostate screening frequency. Cancer Epidemiol Biomarkers Prev 2008, 17(7):1631-1639.
• [16]Schwartz MD, Taylor KL, Willard KS: Prospective association between distress and mammography utilization among women with a family history of breast cancer. J Behav Med 2003, 26(2):105-117.
• [17]McQueen A, Vernon SW, Meissner HI, Rakowski W: Risk perceptions and worry about cancer: does gender make a difference? J Health Commun 2008, 13(1):56-79.
• [18]Byrne MM, Weissfeld J, Roberts MS: Anxiety, fear of cancer, and perceived risk of cancer following lung cancer screening. Med Decis Making 2008, 28(6):917-925.
• [19]Wardle J, McCaffery K, Nadel M, Atkin W: Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations. Soc Sci Med (1982) 2004, 59(2):249-261.
• [20]Orom H, Kiviniemi MT, Shavers VL, Ross L, Underwood W 3rd: Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites. J Behav Med 2013, 36(5):466-476.
• [21]Lee DJ, Consedine NS, Spencer BA: Barriers and facilitators to digital rectal examination screening among African-American and African-Caribbean men. Urology 2011, 77(4):891-898.
• [22]Robb KA, Power E, Atkin W, Wardle J: Ethnic differences in participation in flexible sigmoidoscopy screening in the UK. J Med Screen 2008, 15(3):130-136.
• [23]Consedine NS, Magai C, Neugut AI: The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups. Prev Med 2004, 38(1):64-77.
• [24]Bergua V, Meillon C, Potvin O, Bouisson J, Le Goff M, Rouaud O, Ritchie K, Dartigues JF, Amieva H: The STAI-Y trait scale: psychometric properties and normative data from a large population-based study of elderly people. Int Psychogeriatr 2012, 24(7):1163-1171.
• [25]Bjelland I, Krokstad S, Mykletun A, Dahl AA, Tell GS, Tambs K: Does a higher educational level protect against anxiety and depression? The HUNT study. Soc Sci Med (1982) 2008, 66(6):1334-1345.
• [26]Lemal M, Van den Bulck J: Television news exposure is related to fear of breast cancer. Prev Med 2009, 48(2):189-192.
• [27]Atkin WS, Edwards R, Wardle J, Northover JM, Sutton S, Hart AR, Williams CB, Cuzick J: Design of a multicentre randomised trial to evaluate flexible sigmoidoscopy in colorectal cancer screening. J Med Screen 2001, 8(3):137-144.
• [28]Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, Parkin DM, Wardle J, Duffy SW, Cuzick J: Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010, 375(9726):1624-1633.
• [29]Atkin WS, Cook C, Cuzick J, Edwards R, Northover J, Wardle J: Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 2002, 359(9314):1291-1300.
• [30]Berrenberg JL: The cancer attitude inventory: development and validation. J Psychosoc Oncol 1991, 9(2):35-44.
• [31]Marteau TM, Bekker H: The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992, 31(Pt 3):301-306.
• [32]Miilunpalo S, Vuori I, Oja P, Pasanen M, Urponen H: Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. J Clin Epidemiol 1997, 50(5):517-528.
• [33]Grundy E, Holt G: The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 2001, 55(12):895-904.
• [34]Wardle J, Sutton S, Williamson S, Taylor T, McCaffery K, Cuzick J, Hart A, Atkin W: Psychosocial influences on older adults’ interest in participating in bowel cancer screening. Prev Med 2000, 31(4):323-334.
• [35]Robb KA, Miles A, Campbell J, Evans P, Wardle J: Can cancer risk information raise awareness without increasing anxiety? A randomized trial. Prev Med 2006, 43(3):187-190.
• [36]Cancer Research UK: Key facts. 2010. http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/ webcite
• [37]Sach TH, Whynes DK: Men and women: beliefs about cancer and about screening. BMC Public Health 2009, 9:431.
• [38]Han PK, Moser RP, Klein WM: Perceived ambiguity about cancer prevention recommendations: associations with cancer-related perceptions and behaviours in a US population survey. Health Expect 2007, 10(4):321-336.
• [39]Watts BG, Vernon SW, Myers RE, Tilley BC: Intention to be screened over time for colorectal cancer in male automotive workers. Cancer Epidemiol Biomarkers Prev 2003, 12(4):339-349.
• [40]Sutton S, Bickler G, Sancho-Aldridge J, Saidi G: Prospective study of predictors of attendance for breast screening in inner London. J Epidemiol Community Health 1994, 48(1):65-73.
• [41]Gram IT, Slenker SE: Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited. Am J Public Health 1992, 82(2):249-251.
• [42]Lerman C, Rimer B, Trock B, Balshem A, Engstrom PF: Factors associated with repeat adherence to breast cancer screening. Prev Med 1990, 19(3):279-290.
• [43]Rosenbaum L: “Misfearing”–culture, identity, and our perceptions of health risks. N Eng J Med 2014, 370(7):595-597.
• [44]McCaul KD, Schroeder DM, Reid PA: Breast cancer worry and screening: some prospective data. Health Psychol 1996, 15(6):430-433.
• [45]Bastani R, Gallardo NV, Maxwell AE: Barriers to colorectal cancer screening among ethnically diverse high-and average-risk individuals. J Psychosoc Oncol 2001, 19(3–4):65-84.
• [46]American Psychiatric Association: Diagnostic And Statistical Manual Of Mental Disorders: DSM-IV-TR®. Washington, DC: American Psychiatric Association; 2000.
• [47]Peacock O, Watts ES, Hanna N, Kerr K, Goddard AF, Lund JN: Inappropriate use of the faecal occult blood test outside of the National Health Service colorectal cancer screening programme. Eur J Gastroenterol Hepatol 2012, 24(11):1270-1275.
• [48]White DB, Bonham VL, Jenkins J, Stevens N, McBride CM: Too many referrals of low-risk women for BRCA1/2 genetic services by family physicians. Cancer Epidemiol Biomarkers Prev 2008, 17(11):2980-2986.
• [49]Patel RS, Smith DC, Reid I: One stop breast clinics–victims of their own success? A prospective audit of referrals to a specialist breast clinic. Eur J Surg Oncol 2000, 26(5):452-454.
• [50]Burgess CC, Ramirez AJ, Richards MA, Love SB: Who and what influences delayed presentation in breast cancer? Br J Cancer 1998, 77(8):1343-1348.
• [51]Burgess CC, Potts HW, Hamed H, Bish AM, Hunter MS, Richards MA, Ramirez AJ: Why do older women delay presentation with breast cancer symptoms? Psychooncology 2006, 15(11):962-968.
• [52]Azaiza F, Cohen M: Colorectal cancer screening, intentions, and predictors in Jewish and Arab Israelis: a population-based study. Health Educ Behav 2008, 35(4):478-493.
• [53]Subramanian S, Klosterman M, Amonkar MM, Hunt TL: Adherence with colorectal cancer screening guidelines: a review. Prev Med 2004, 38(5):536-550.
• [54]Organisation for Economic Co-operation and Development (OECD): Education at a glance 2013. [http://www.oecd.org/edu/eag.htm webcite]: OECD; 2013
• [55]Office for National Statistics: Focus on Ethnicity and Identity, Summary Report. [http://www.ons.gov.uk/ons/rel/ethnicity/focus-on-ethnicity-and-identity/focus-on-ethnicity-and-identity-summary-report/index.html webcite]; March 2005