Knowledge of lung cancer symptoms and risk factors in Britain – development of a measure and results from a population-based survey


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Alice Simon1, Dorota Juszczyk1, Nina Smyth1, Emily Power1, Sara Hiom2, Jane Wardle1
1University College London, London, UK, 2CR-UK London Research Institute, London, UK


Lung cancer is commonly diagnosed at a late stage, with poor survival. However, there are symptoms associated with the primary tumour, and awareness of these can lead to earlier help-seeking. Awareness of risk factors may also be important by encouraging smoking cessation and awareness of personal risk. This paper describes two linked studies. The first describes the development and validation of the Lung Cancer Awareness Measure (Lung CAM). The second study provides baseline data using the Lung CAM in a population-based survey and explores the demographic and social predictors of lung cancer awareness.


Study 1: Symptoms and risk factors for lung cancer were identified from the medical literature and health professional expertise in an iterative process. Test-retest reliability, internal reliability, item analyses, construct validity, and sensitivity to changes in awareness of the Lung CAM were assessed in three samples (total N=191).

Study 2: 1484 adults completed the Lung CAM in a face-to-face, computer-assisted interview as part of a population-based survey.


Study 1:  The Lung CAM demonstrated good internal (Cronbach’s alpha=0.86) and test-retest reliability (r=0.81, p<0.001).  Lung cancer experts scored higher than equally educated controls (t(68)=7.2, p<0.001) and volunteers randomised to read lung cancer information scored higher than those reading a control leaflet (t(81)=3.66, p<0.001); supporting the validity of the measure.

Study 2: Symptom awareness was low (average recall of one symptom) and there was little awareness of risk factors other than smoking.  Familiarity with cancer, and being from a higher socio-economic group were associated with greater awareness.


Using a valid and reliable tool for assessing awareness, the UK population revealed low awareness of lung cancer symptoms and risk factors.  Interventions to increase lung cancer awareness are needed to improve early detection behaviour.