Full Paper

BJC Open article

British Journal of Cancer (2009) 101, S18–S23. doi:10.1038/sj.bjc.6605386 www.bjcancer.com
Published online 3 December 2009

Public awareness of cancer in Britain: a population-based survey of adults

K Robb1, S Stubbings1, A Ramirez2, U Macleod3, J Austoker4, J Waller1, S Hiom5 and J Wardle1

  1. 1Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK
  2. 2Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, King's College London, St Thomas' Hospital, London, UK
  3. 3General Practice and Primary Care, Division of Community Based Sciences, Faculty of Medicine, 1 Horselethill Road, Glasgow, UK
  4. 4Cancer Research UK Primary Care Education Research Group, Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, UK
  5. 5Health Information Department, Cancer Research UK, 61 Lincoln's Inn Fields, London, UK

Correspondence: Professor J Wardle, E-mail: j.wardle@ucl.ac.uk





To assess public awareness of cancer warning signs, anticipated delay and perceived barriers to seeking medical advice in the British population.



We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the cancer awareness measure (CAM), a newly developed, validated measure of cancer awareness. The sample included 2216 adults (970 males and 1246 females) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling.



Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socio-economic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help seeking were difficulty making an appointment, worry about wasting the doctor's time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay.



A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes.


cancer awareness; symptom awareness; anticipated delay; barriers; cancer warning signs