br Figure Recognition and anticipating delay weeks
Figure 1. Recognition and anticipating delay >2 weeks before care seeking for each related cancer symptom.
Note: Asterisk indicates a significant difference between symptom aware and unaware at p<0.05. White bar indicates symptom unaware; black bar indicates symptom aware.
Table 3. Weighted Multivariate Correlates of Anticipated Delay Before Seeking Care for Potential Cancer Symptom
Variable (95% CI) p-value
Recognize as cancer symptom?
Married/Cohabiting 1.00 (ref)
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Table 3. Weighted Multivariate Correlates of Anticipated Delay Before Seeking Care for Potential Cancer Symptom (continued)
Variable (95% CI) p-value
Somewhat/Very easy 1.00 (ref)
Note: Sample sizes are different across models because of missing data. Breast changes model includes females only. Boldface indicates statistical significance (p<0.05). aRectal bleeding model fit (F9,1275 = 5.105, p>0.001); no indication of poor model Lipoxin A4 for other models.
any, dermatologists. Given the rising incidence of mela-noma among older adults,35 and the unlikelihood of rapid changes in the availability of dermatologists, more research is warranted to identify modifiable factors that influence delay in care seeking for mole changes.
This study, which has a cross-sectional design, is limited in its ability to make causal conclusions about the rela-tionship between symptom awareness and delay in help seeking. There are limitations to measuring anticipated delay rather than actual time to care. Though studies examining actual time to care seeking for cancer symp-toms also show that lack of symptom recognition is asso-ciated with a greater delay,14 anticipated delays may be shorter than actual delays.8 Indeed, the processes of notic-ing a symptom, appraising it as a potential sign of cancer, and then deciding to seek medical care are likely to be more complex than recognizing a symptom in the research context.23 For example, there is some mixed evi-dence from the UK that although those with lower educa-tion anticipate less delay, they may be less likely to associate a symptom with cancer.27,28 Thus, additional research is needed to examine the effect of symptom rec-ognition on actual, rather than anticipated, care-seeking behaviors for different U.S. groups. Strengths of this study include the large population-based sample and assessment of recognition of specific symptoms (rather than general symptom awareness) and anticipated delay for each,
which may be more accurate given the known variability in care seeking across different symptoms. In addition, a strength of this study is that it allows for direct interna-tional comparisons about cancer symptom awareness and delays across countries rather than indirect comparisons because the study team administered the ABC survey.
Because most cancers are diagnosed symptomatically, in the U.S. as in other countries,2 identifying modifiable fac-tors to reduce delay in care seeking for potential symp-toms of cancer is important for promoting earlier diagnoses and better outcomes. This study provides the first evidence that the U.S. population recognizes symp-toms of cancer as well as the populations of countries with national healthcare systems. In addition to the recog-nition of warning signs of cancer, future studies should examine other factors, such as beliefs about cancer9 and specific barriers to care36 that are likely to influence care seeking for potential symptoms of cancer. Public health interventions focused on increasing awareness of timely care for symptoms of cancer may also be necessary.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute.
These findings were presented at the 42nd Annual American Society of Prevention Oncology Conference in March 2018.
No financial disclosures were reported by the authors of this paper.
5. Macdonald S, Macleod U, Campbell NC, Weller D, Mitchell E. Sys-tematic review of factors influencing patient and practitioner delay in diagnosis of upper gastrointestinal cancer. Br J Cancer. 2006;94