Ovarian cancer symptom awareness and anticipated presentation in a population sample


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Kate Brain1, Stephanie Smits1, Alice Simon2, Chris Roberts3, Iain Robbe1, John Steward4, Ceri White4, Richard Neal5, Jane Hanson6
1Cardiff University School of Medicine, Cardiff, UK, 2City University, London, UK, 3Welsh Government, Cardiff, UK, 4Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK, 5Bangor University, Wrexham, UK, 6Cancer National Specialist Advisory Group, Cardiff, UK

Background

Ovarian cancer has early identifiable symptoms, yet theoretically based studies of symptom awareness and anticipated presentation behaviour are lacking. A population-based survey was conducted to identify key theoretical drivers of awareness and anticipated early symptomatic presentation.

Method

As part of the International Cancer Benchmarking Partnership, 1043 women aged over 50 years in Wales responded to a population-based survey using random probability sampling methods. Computer-assisted telephone interviews were used to administer the Awareness and Beliefs about Cancer measure adapted for ovarian cancer (ABC-O). Measures included ovarian cancer symptom recognition, anticipated presentation, perceived risk of ovarian cancer, perceived benefits/barriers to timely presentation, confidence in symptom detection, ovarian cancer worry, and demographic variables.

Results

The most recognised symptoms were post-menopausal bleeding and persistent pelvic/abdominal pain. Eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower awareness was associated with lower confidence in symptom appraisal (p≤.001), lower education (p≤.01), older age (p≤.01), lack of personal experience of ovarian cancer (p≤0.01), and lower perceived risk (p≤0.01). Longer anticipated time to presentation was more likely in women educated to degree level (p≤.001), with more practical (p≤.001) and emotional barriers (p≤.01), and less confidence (p≤.001).

Conclusion

Many ovarian symptoms are not well recognised by women in the general population. Ovarian cancer awareness and anticipated help-seeking for potential symptoms have different underlying mechanisms, but lack of confidence is a common barrier to awareness and prompt presentation. Alongside clinical evidence, theory-based interventions are needed to improve women's confidence in both appraising and acting on ovarian symptoms, if delays in presentation are to be minimised.