World Cancer Day Survey Exposes 'Glaring Inequities'

Kristin Jenkins

February 04, 2020

The first international public survey on cancer perceptions and attitudes in a decade shows that, in spite of progress, low socioeconomic status and lack of education continue to jeopardize the health of the world's most vulnerable populations.

The survey was commissioned by the Union for International Cancer Control (UICC) to mark the 20th anniversary of World Cancer Day on February 4.

The survey, which was conducted by Ipsos, was taken by more than 15,000 people in 20 countries. It shows that people of lower socioeconomic status are less likely than those in higher-income households to recognize the risk factors for cancer or to make lifestyle changes. With the exception of tobacco use, people with low educational attainment also showed less cancer awareness and were less likely to engage in preventive behaviors than those with a university degree.

It is "unacceptable that millions of people have a greater chance of developing cancer in their lifetime because they are simply not aware of the cancer risks to avoid and the healthy behaviors to adopt ― information that many of us take for granted. And this is true around the world," Cary Adams, MBA, chief executive officer of the UICC, commented in a statement.

The survey was conducted from October 25 to November 25, 2019, and included 15,427 participants from Australia, Bolivia, Brazil, Canada, China, France, Germany, Great Britain, India, Israel, Japan, Kenya, Mexico, the Philippines, Saudi Arabia, South Africa, Spain, Sweden, Turkey, and the United States.

The vast majority of those surveyed — 87% — said they were aware of the major risk factors for cancer, while only 6% said they were not.

The cancer risk factors that were most recognized were tobacco use (63%), ultraviolet light exposure (54%), and exposure to secondhand tobacco smoke (50%).

The cancer risks that were least recognized included being overweight (29%), a lack of exercise (28%), and exposure to certain viruses or bacteria (28%).

The difference in awareness across the social spectrum was striking. "Emerging from the survey are the apparent and glaring inequities faced by socioeconomically disadvantaged groups," say the authors.

"Much more must be done to ensure that everyone has an equal chance to reduce their risk of preventable cancer," commented Sonali Johnson, PhD, head of knowledge, advocacy, and policy at the UICC, in Geneva, Switzerland.

"We've seen in the results that those surveyed with a lower education and those on lower incomes appear less aware of the main risk factors associated with cancer and thus are less likely to proactively take the steps needed to reduce their cancer risk as compared to those from a high income household or those with a university education," Johnson told Medscape Medical News.

Does increased cancer awareness translate into behavioral change for the better? This question can only be answered by more research, say the survey authors. They report that 7 of 10 survey respondents (69%) said they had made a behavioral change to reduce their cancer risk within the past 12 months. Most said they were eating more healthfully.

Slightly fewer than one quarter reported that they had not taken any preventive measures in the past year.

When it comes to raising cancer awareness, World Cancer Day is "a powerful tool to remind every person that they can play a crucial role in reducing the impact of cancer," said Johnson.

Healthcare Providers Are "Crucial"

Reacting to the findings of the survey, the European Society for Medical Oncology (ESMO) emphasized the key role that physicians play in cancer prevention.

"Research speaks very clearly for prevention," said ESMO President Solange Peters, MD, PhD. "With the number of cancer cases expected to rise to 29.5 million by 2040, we must act now. ESMO is committed to educating doctors on all aspects of cancer control, which should begin well before a cancer diagnosis.

"In the face of this emergency, which is rendered even more salient by the results of the report, we must work to enlarge the basis of doctors who are properly educated and trained in key prevention measures," Peters added. "General practitioners and organ specialists are in the front line to guide and support patients on their quest for healthy lifestyles and reliable ways to detect cancer early."

Commenting to Medscape Medical News, Johnson acknowledged the role physicians play in health promotion and informing patients about noncommunicable disease risks, including those related to cancer. However, she emphasized that nurses, pharmacists, community health workers, midwives, and other healthcare providers who deliver primary care "are crucial around the world to imparting health information and offering services."

Frontline healthcare workers can assess patients' cancer knowledge and health literacy, determine the barriers to healthcare, and assess "how best to engage with people across the life course," Johnson explained. "Rather than just focusing on physicians, we must work with all those involved in primary care, especially as primary care services are scaled up to achieve universal health coverage."

Call on Governments to Do More

The authors note that although there is wide awareness of the cancer risks from tobacco use, adults younger than 35 years were less likely than those older than 50 to identify tobacco as a cancer risk factor. They describe this finding as "most concerning" and say it "underscores the ongoing need to raise awareness about cancer risk factors in every new generation."

Almost 60% of survey respondents, regardless of age, education, or income, expressed concern about being diagnosed with cancer in the future or having cancer recur.

In Kenya, where the death toll from cancer rose 30% from 2014 to 2018, people appeared to be the most worried about cancer, with 4 of 5 survey respondents (82%) expressing concern.

Survey respondents from Saudi Arabia appeared the least concerned, with 1 of 3 people saying they were worried.

Notably, 84% of survey respondents said that governments should be doing more to increase cancer prevention and awareness; 33% demanded that governments improve the affordability of cancer care.

"It is understandable that people turn to their governments for support," Johnson commented. "Affordability is a big challenge for low-income settings."

Data from the World Health Organization (WHO) show that for every US$1 invested in low- and middle-income countries, the return is US$3.20, Johnson pointed out. "We really need to convince decision makers...and see the right investments being made. It is important to ensure that the health system strengthening takes place in tandem with prevention services."

Governments have begun making commitments to tackle noncommunicable diseases and cancer, Johnson commented. He highlighted the WHO's Global Action Plan for Healthy Lives and Well-being for All and the updated cancer resolution adopted at the 2017 World Health Assembly.

"Education, training, and awareness-raising efforts need to be backed by strong and progressive health policies that prioritize prevention and help reduce the consumption of known cancer-causing products such as tobacco, sugary food, and beverages," she said. "Countries should also invest proactively in national cancer control planning and the establishment of population-based registries to ensure the most effective resource allocation that benefits all groups."

Up-to-date information on cancer risks and cancer prevention must be delivered to the public in ways that are accessible to those in lower socioeconomic groups, Johnson added. "Awareness needs to be raised continuously with each new generation," she noted.

The UICC has relationships with Astellas, Daiichi-Sanko, Diaceutics, MSD Inventing for Life, Bristol-Myers Squibb, CUBEBIO, the Icon Group, Roche, and Sanofi.

UICC. The International Public Opinion Survey on Cancer 2020. Published online on February 4, 2020. Full text

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