Patterns of symptoms possibly indicative of cancer and associated help-seeking behaviour in a large sample of United Kingdom residents—The USEFUL study

Autoři: Philip C. Hannaford aff001;  Alison J. Thornton aff001;  Peter Murchie aff001;  Katriina L. Whitaker aff002;  Rosalind Adam aff001;  Alison M. Elliott aff003
Působiště autorů: Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom aff001;  School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom aff002;  Graduate School, Abertay University, Dundee, United Kingdom aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0228033



Cancer awareness campaigns aim to increase awareness of the potential seriousness of signs and symptoms of cancer, and encourage their timely presentation to healthcare services. Enhanced understanding of the prevalence of symptoms possibly indicative of cancer in different population subgroups, and associated general practitioner (GP) help-seeking behaviour, will help to target cancer awareness campaigns more effectively.


To determine: i) the prevalence of 21 symptoms possibly indicative of breast, colorectal, lung or upper gastrointestinal cancer in the United Kingdom (UK), including six ‘red flag’ symptoms; ii) whether the prevalence varies among population subgroups; iii) the proportion of symptoms self-reported as presented to GPs; iv) whether GP help-seeking behaviour varies within population subgroups.


Self-completed questionnaire about experience of, and response to, 25 symptoms (including 21 possibly indicative of the four cancers of interest) in the previous month and year; sent to 50,000 adults aged 50 years or more and registered with 21 general practices in Staffordshire, England or across Scotland.


Completed questionnaires were received from 16,778 respondents (corrected response rate 34.2%). Almost half (45.8%) of respondents had experienced at least one symptom possibly indicative of cancer in the last month, and 58.5% in the last year. The prevalence of individual symptoms varied widely (e.g. in the last year between near zero% (vomiting up blood) and 15.0% (tired all the time). Red flag symptoms were uncommon. Female gender, inability to work because of illness, smoking, a history of a specified medical diagnosis, low social support and lower household income were consistently associated with experiencing at least one symptom possibly indicative of cancer in both the last month and year. The proportion of people who had contacted their GP about a symptom experienced in the last month varied between 8.1% (persistent cough) and 39.9% (unexplained weight loss); in the last year between 32.8% (hoarseness) and 85.4% (lump in breast). Nearly half of respondents experiencing at least one red flag symptom in the last year did not contact their GP about it. Females, those aged 80+ years, those unable to work because of illness, ex-smokers and those previously diagnosed with a specified condition were more likely to report a symptom possibly indicative of cancer to their GP; and those on high household income less likely.


Symptoms possibly indicative of cancer are common among adults aged 50+ years in the UK, although they are not evenly distributed. Help-seeking responses to different symptoms also vary. Our results suggest important opportunities to provide more nuanced messaging and targeting of symptom-based cancer awareness campaigns.

Klíčová slova:

Blood – Cancer detection and diagnosis – Coughing – Health education and awareness – Lung and intrathoracic tumors – Questionnaires – Vomiting – Gastrointestinal cancers


1. Arnold M, Rutherford MJ, Bardot A, Ferlay J, Andersson TM-L, Åge Myklebust T et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol 2019 Published Online September 11, 2019

2. Achieving world-class cancer outcomes. A strategy for England 2015–2020. Report of the Independent Cancer Taskforce. 2015, NHS London, England

3. Beating cancer: ambition and action. 2016, The Scottish Government, Edinburgh, Scotland

4. Whitaker KL, Scott SE, Winstanley K, Macleod U, Wardle J. Attributions of cancer ‘alarm’ symptoms in a community sample. PLOS One 2014; 9: e114028. doi: 10.1371/journal.pone.0114028 25461959

5. Corner J, Hopkinson J, Roffe L. Experience of health changes and reasons for delay in seeking care: A UK study of the months prior to the diagnosis of lung cancer. Social Science and Medicine 2006; 62: 1381–1391. doi: 10.1016/j.socscimed.2005.08.012 16168544

6. Corner J, Hopkinson J, Fitzsimmons D, Barclay S, Muers M. Is late diagnosis of lung cancer inevitable? Interview study of patients’ recollections of symptoms before diagnosis. Thorax 2005; 60: 314–319. doi: 10.1136/thx.2004.029264 15790987

7. Smith SM, Campbell NC, MacLeod U, Lee AJ, Raja A, Wyke S et al. Factors contributing to time taken to consult with symptoms of lung cancer: a cross-sectional study. Thorax 2009; 64: 523–531. doi: 10.1136/thx.2008.096560 19052045

8. Weinstein ND, Marcus SE, Moser RP. Smokers’ unrealistic optimism about their risk. Tobacco Control 2005; 14: 55–59. doi: 10.1136/tc.2004.008375 15735301

9. Grunfeld EA, Ramirez AJ, Hunter MS, Richards MA. Women’s knowledge and beliefs regarding breast cancer. British Journal of Cancer 2002; 86: 1373–1378. doi: 10.1038/sj.bjc.6600260 11986766

10. McCaffery K, Wardle J, Waller J. Knowledge, attitudes and behavioural intentions in relation to the early detection of colorectal cancer in the United Kingdom. Preventive Medicine 2003; 36: 525–535. doi: 10.1016/s0091-7435(03)00016-1 12689797

11. Linsell L, Burgess CC, Ramirez AJ. Breast cancer awareness among older women. British Journal of Cancer 2008; 99: 1221–1225. doi: 10.1038/sj.bjc.6604668 18813307

12. Robb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Waller J et al. Public awareness of cancer in Britain: a population-based survey of adults. British Journal of Cancer 2009; 101: S18–S23.

13. Svendsen RP, Stovring H, Hansen BL, Kragstrup J, Sondergaard J, Jarbol DE. Prevalence of cancer alarm symptoms: A population-based cross-sectional study. Scandinavian Journal of Primary Health Care 2010; 28: 132–137. doi: 10.3109/02813432.2010.505412 20698729

14. Elnegaard S, Andersen RS, Pedersen AF, Larsen PV, Sødergaard J, Rasmussen S et al. Self-reported symptoms and healthcare seeking in the general population–exploring “The Symptom Iceberg.” BMC Public Health 2015; 15: 685. doi: 10.1186/s12889-015-2034-5 26195232

15. Whitaker KL, Friedemann Smith C, Winstanley K, Wardle J. What prompts help-seeking for cancer ‘alarm’ symptoms? A primary care based survey. British Journal of Cancer 2015; 114: 334–339.

16. Stubbings S, Robb KA, Waller J, Ramirez A, Austoker J, Macleod U et al. Development of a measurement tool to assess public awareness of cancer. 2009;101: S13–17.

17. Elliott AM, McAteer A, Hannaford PC. Revisiting the symptom iceberg in today’s primary care: results from a UK population survey. BMC Family Practice 2011; 12: 16. doi: 10.1186/1471-2296-12-16 21473756

18. McAteer A, Elliott AM, Hannaford PC. Ascertaining the size of the symptom iceberg in a UK-wide community-based survey. British Journal of General Practice 2011; 61: e1–11. doi: 10.3399/bjgp11X548910 21401979

19. Scott SE, Walter FM, Webster A., Sutton S, Emery J, The Model ofPathways to Treatment: Conceptualization and integration with existing theory. British Journal of Health Psychology. 2013; 18: 45–65. doi: 10.1111/j.2044-8287.2012.02077.x 22536840

20. Leventhal H Meyer D, N.D. The common sense representation of illness danger. In Rachman S (ed). Medical Psychology (vol II). 1980, Pergamon Press, New York, USA

21. Dingwall R. Aspects of Illness. 2001. Ashgate publishing Ltd, Farnham, England.

22. Pescosolido BA. Beyond Rational Choice: The Social Dynamics of How People Seek Help. American Journal of Sociology. 1992; 97: 1096–1138.

23. (accessed 3.1.19).

24. (accessed 3.1.19).

25. (accessed 3.1.19).

26. (accessed 11.10.19).

27. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.


29. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. Journal of psychosomatic research, 2006; 60: 631–637. doi: 10.1016/j.jpsychores.2005.10.020 16731240

30. Baughman P, O’Neill B, Fletcher E. Auditing the diagnosis of cancer in primary care: the experience in Scotland. British Journal of Cancer 2009; 101: S87–S91. doi: 10.1038/sj.bjc.6605397 19956170

31. Olesen F, Hansen RP, Vedsted P. Delay in diagnosis: the experience in Denmark. British Journal of Cancer 2009; 101: S6–S8. doi: 10.1038/sj.bjc.6605269

32. Jensen AR, Mainz J, Overgaard J. Impact of delay on diagnosis and treatment of primary lung cancer. Acta Oncologica 2002; 41: 147–152. doi: 10.1080/028418602753669517 12102158

33. Tromp DM, Brouha XDR, De Leeuw JRJ, Hordijk GJ, Winnubst JAM. Psychological factors and patient delay in patients with head and neck cancer. European Journal of Cancer 2004; 40: 1509–1516. doi: 10.1016/j.ejca.2004.03.009 15196534

34. Smith LK, Pope C, Botha J. Patient’s help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 2005; 366: 825–831. doi: 10.1016/S0140-6736(05)67030-4 16139657

35. Andersen RS, Vedsted P, Olesen F, Bro F, Sondergaard J. Patient delay in cancer studies: a discussion of methods and measures. BMC Health Services Research 2009; 9:189. doi: 10.1186/1472-6963-9-189 19840368

36. Birring SS, Peake MD. Symptoms and the early diagnosis of lung cancer. Thorax 2005; 60: 268–269. doi: 10.1136/thx.2004.032698 15790977

37. National Institute for Health and Clinical Excellence. Referral for suspected cancer: a clinical practice guideline. National Clinical Practice Guideline Number 27. National Institute for Health and Clinical Excellence, 2005: London:

38. Scottish Executive. Scottish referral guidelines for suspected cancer. Scottish Executive 2007: Edinburgh.

39. Sheikh I, Ogden J. The role of knowledge and beliefs in help-seeking behaviour for cancer: a quantitative and qualitative approach. Patient Education and Counselling 1998; 35: 35–42.

40. Tentzeris V, Lake B, Cherian T, Milligan J, Sigurdsson A. Poor awareness of symptoms of oesophageal cancer. Interactive Cardiovascular and Thoracic Surgery 2011; 12: 32–34. doi: 10.1510/icvts.2010.247213 20926460

41. Galea S, Tracy M. Participation rates in epidemiologic studies. Annuals of Epidemiology 2007; 17: 643–653.

42. Morton LM, Cahill J, Hartage P. Reporting participation in epidemiologic studies: a survey of practice. American Journal of Epidemiology 2006; 163: 197–203. doi: 10.1093/aje/kwj036 16339049

43. Edwards PJ, Roberts I, Clarke MJ, Diguiseppi C, Wentz R, Kwan I, Cooper R et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Systematic Reviews. 2009, 3: MR000008.

44. Smith SM, Whitaker KL, Cardy AH, Elliott AM, Hannaford PC, Murchie P. Validation of self-reported help-seeking, and measurement of the patient interval, for cancer symptoms: an observational study to inform methodological challenges in symptomatic presentation research. Family Practice 2019, 1–7 doi: 10.1093/fampra/cmz047 31529030

45. Svendsen RP, Paulsen MS, Larsen PV, Hansen BL, Stǿvring H, Jarbǿl DE et al. Associations between reporting of cancer alarm symptoms and socioeconomic and demographic determinants: a population-based, cross-sectional study. BMC Public Health 2012; 12: 686. doi: 10.1186/1471-2458-12-686 22914003

46. Power E, Wardle J. Change in public awareness of symptoms and perceived barriers to seeing a doctor following Be Clear on Cancer campaigns in England. Brit J Cancer, 2015; 112, S22–S26. doi: 10.1038/bjc.2015.32 25734386

Článek vyšel v časopise


2020 Číslo 1