Cancer-related beliefs and behaviour in low-, middle- and
high-income countries Slide 2 Overview Survey development and
methodology Participating countries Risk factor behaviour Screening
and diagnosis Cancer prevention beliefs Risk factors and prevention
beliefs Slide 3 Why do a population survey? Beliefs influence
lifestyle choices, participation in screening and treatment
decisions Cancer prevention programmes need to be informed by local
population data to design programmes and evaluate progress Aims:
Enhance collection of comparable population survey data about
cancer beliefs and behaviours across countries where there are UICC
member organizations Develop capacity in UICC member organizations
to use such survey data to develop population-based cancer control
programmes and policies and evaluate their impact Slide 4 Survey
development The UICC partnered with Roy Morgan Research Company and
Gallup International Technical advisory group to advise on survey
development and reporting: Dr Melanie Wakefield, Australia Dr
Sharon Campbell, Canada Dr Michael Stefanek, USA Dr Jane Wardle,
Britain Dr Hein de Vries, Netherlands Slide 5 Survey methodology
Data collection commenced in October 2007 The same survey questions
were asked, regardless of administration method, in the language/s
spoken by the majority of each countrys population Randomly
selected population sample Administered face to face or by phone,
depending on the countrys infrastructure Often as part of Gallup
affiliate omnibus survey to defray costs For the information
presented in the subsequent slides, the margin of error is 1.32%
Slide 6 Standard set of questions Personal characteristics (age,
sex, employment status, occupation, religion, personal cancer
experience, family cancer experience) Risk factor behaviour
(smoking, alcohol use, physical activity, sun protection, body mass
index) Screening participation Beliefs about treatment Beliefs
about risk factors for cancer Slide 7 First 29 countries
participating in survey Australia (1272) Austria (920) Bolivia
(1296) Canada (1070) China (1000) Czech Republic (500) Dominican
Republic (500) Georgia (1000) Greece (500) Guatemala (500)
Indonesia (1081) Israel (992) Kenya (500) Lebanon (500) Mexico
(518) New Zealand (858) Nigeria (5021) Panama (502) Peru (1206)
Philippines (1000) Romania (947) Serbia (1004) Spain (1000) Turkey
(2019) Ukraine (1137) United Kingdom (691) United States of America
(855) Uruguay (500) Venezuela (1036) Slide 8 Categorization of
these countries: World Bank income groups CategoryIncluded
countries Low income (N=5521) Kenya Nigeria Middle income (N=15746)
Bolivia China Dominican Republic Georgia Guatemala Indonesia
Lebanon Mexico Panama Peru Philippines Romania Ukraine Serbia
Turkey Venezuela Uruguay High income (N=8658) Australia Austria
Canada Czech Republic Greece Israel New Zealand Spain UK USA Slide
9 12 additional countries (awaiting data) Albania Algeria Belgium
Ethiopia Finland Germany Ghana India Italy Ivory Coast Pakistan
Switzerland Slide 10 Categorization of all 41 countries: World Bank
income groups CategoryIncluded countriesAdditional countries Low
income (N=5521) Kenya Nigeria Ethiopia Ghana India Ivory Coast
Pakistan Middle income (N=15746) Bolivia China Dominican Rep.
Georgia Guatemala Indonesia Lebanon Mexico Panama Peru Philippines
Romania Ukraine Serbia Turkey Venezuela Uruguay Albania Algeria
High income (N=8658) Australia Austria Canada Czech Republic Greece
Israel New Zealand Spain UK USA Belgium Finland Germany Italy
Switzerland Slide 11 Risk factor behaviour Smoking status Alcohol
consumption Level of physical activity Weight Sun exposure Slide 12
Prevalence of tobacco use Tobacco use was determined by asking In
the last 12 months have you used any tobacco products If
respondents indicated that they had used cigarettes, roll your own
tobacco, pipe, cigars, chewing tobacco, snuff or bidis they were
classified as a tobacco user If respondents replied no, none they
were classified as not being a tobacco user As illustrated in the
next figure, there was a large difference in the prevalence of
tobacco users in low-income countries in comparison to tobacco
users in middle- and high-income countries Slide 13 Prevalence of
tobacco use Slide 14 Tobacco use was determined by asking In the
last 12 months have you used any tobacco products If respondents
indicated that they had used cigarettes, roll-your- own tobacco,
pipe, cigars, chewing tobacco, snuff or bidis they were classified
as a tobacco user If respondents replied no, none they were
classified as not using tobacco As illustrated in the next figure,
across income categories, tobacco use is more prevalent amongst
males than females This gender difference is most pronounced in the
low-income category, where males are 11 times more likely than
females to use tobacco Prevalence of tobacco use Slide 15 Slide 16
Alcohol consumption Alcohol consumption was determined by asking In
the last 12 months have you had an alcoholic drink of any kind? If
yes, about how often do you have an alcoholic drink? If respondents
replied most days or 5 or 6 days a week they were classified as a
frequent consumer If they replied 3 or 4 days a week or once a week
they were classified as a moderate consumer If respondents replied
2 or 3 times a month once a month less often or rarely they were
classified as an occasional consumer Individuals who responded no,
never, or dont drink were classified as never consuming alcohol.
The majority of respondents in low-income countries do not drink
alcohol Respondents in high-income countries were nearly three
times more likely to identify that they were frequent alcohol
consumers Slide 17 Alcohol consumption Slide 18 Vigorous physical
activity Physical activity was assessed by asking How often do you
do hard physical or vigorous activity in three contexts: work;
home; or at a gym, sports place or somewhere else Based on National
Physical Activity Guidelines for Australians, a recommended level
of physical activity was engaging in activity most days, 5 or 6
days a week Less than recommended was engaging in physical activity
3 or 4 days a week once a week, 2 or 3 times a month, once a month,
less often, rarely or never In low- and high-income countries, more
physical activity was occurring at home than at work or at a gym
Those in high-income countries appear to engage in higher overall
physical activity than others Slide 19 Vigorous physical activity
Slide 20 Body mass index Estimates of height and weight were used
to calculate BMI Respondents were then classified as being either
of an acceptable/healthy weight or as overweight/obese based on WHO
weight recommendations Those in middle-income countries were the
only group where the majority of respondents were of a healthy
weight Note: Question not asked of respondents in Austria and
Israel Slide 21 Body mass index Slide 22 Sun exposure Sun exposure
was determined by asking, In the last 12 months have you been
sunburnt? By sunburnt I mean any reddening of the skin after being
outside in the sun? As illustrated in the figure, the majority of
respondents did not report being sunburnt in the last 12 months.
However, a greater percentage of those in high-income countries
reported being sunburnt than others Slide 23 Sun exposure Slide 24
Screening and diagnosis Cancer screening Individual and immediate
family cancer diagnosis Beliefs about a cure for cancer following
diagnosis Expectations about medical treatment decision-making
Slide 25 Cancer screening Individuals were asked Have you ever had
a cancer screening test, blood test, or some other test for cancer?
If respondents replied yes, they were asked, Which, if any, of the
following cancer tests have you had? Bowel or colon cancer check;
Skin cancer check; Lung cancer check; (if female) pap test or pap
smear; (if female) mammogram or breast x-ray; (if male) prostate
check; other check In low- and middle-income countries, over 80% of
respondents reported not being screened for cancer Those in
high-income countries were 4.9 times more likely (and middle-income
respondents were 1.7 times more likely) to report being screened
for cancer than those in low-income countries Slide 26 Cancer
screening Slide 27 Previous cancer screening Individuals were asked
Have you ever had a cancer screening test, blood test, or some
other test for cancer? If respondents replied yes they were asked
Which, if any, of the following cancer tests have you had? Bowel or
colon cancer check; Skin cancer check; Lung cancer check; (if
female) pap test or pap smear; (if female) mammogram or breast
x-ray; (if male) prostate check; other check In low-income
countries, screening experience did not vary by age, but it
increased with age in other countries In high-income countries, 65%
of respondents aged 40+ reported previous screening for cancer,
compared with 30% and 11% respectively of those in middle- and
low-income countries Slide 28 Previous cancer screening Slide 29
Males were asked Have you ever had a cancer screening test, blood
test, or some other test for cancer? If respondents replied yes,
they were asked, Which, if any, of the following cancer tests have
you had?Bowel or colon cancer check; Skin cancer check; Lung cancer
check; prostate check; other check Within low- and middle-income
countries, over 85% of males reported not being previously screened
for cancer In high-income countries, 56% of males had not been
previously screened Slide 30 Previous cancer screening Slide 31
Males were asked Have you ever had a cancer screening test, blood
test, or some other test for cancer? If respondents replied yes
they were asked, Which, if any, of the following cancer tests have
you had? Bowel or colon cancer check; Skin cancer check; Lung
cancer check; prostate check; other check In the middle-income
category, over one third of men aged 60+ reported screening,
compared with over two-thirds of men aged 60+ in high income
countries Screening increased with age in both middle- and
high-income countries, but not in low-income countries Slide 32
Previous cancer screening Slide 33 Females were asked Have you ever
had a cancer screening test, blood test, or some other test for
cancer? If respondents replied yes they were asked Which, if any,
of the following cancer tests have you had? Bowel or colon cancer
check; Skin cancer check; Lung cancer check; pap test or pap smear;
mammogram or breast x-ray; other check Only within the high-income
category did the majority of females report being previously
screened for cancer Previous cancer screening Slide 34 Slide 35
Females were asked Have you ever had a cancer screening test, blood
test, or some other test for cancer? If respondents replied yes
they were asked Which, if any, of the following cancer tests have
you had? Bowel or colon cancer check; Skin cancer check; Lung
cancer check; pap test or pap smear; mammogram or breast x-ray;
other check Screening gradually increases with age in middle-income
countries but not in low-income countries In high-income countries,
screening rates doubled between the age categories of 18-29 years
and 40-49 years Previous cancer screening Slide 36 Slide 37 Females
were asked Have you ever had a cancer screening test, blood test,
or some other test for cancer? If respondents replied yes they were
asked if they had previously had a pap test or pap smear In
high-income countries, 48% of women reported having a pap smear,
compared with 16% and 3% respectively in middle- and low-income
countries Women in high-income countries are 16 times more likely
(and women in middle-income countries are 5.3 times more likely) to
report having had a pap test than women in low-income countries
Previous cancer screening Slide 38 Slide 39 Females were asked Have
you ever had a cancer screening test, blood test, or some other
test for cancer? If respondents replied yes, they were asked if
they had previously had a pap test or pap smear Less than 5% of
each age group of women in the low-income countries reported having
had a pap test In high-income countries, there was a sharp increase
in the number of women reporting a previous pap test after the age
of 30, in comparison to women aged 18-29 This trend was less
marked, but still apparent, in middle-income countries Previous
cancer screening Slide 40 Slide 41 Females were asked Have you ever
had a cancer screening test, blood test, or some other test for
cancer? If respondents replied yes, they were asked if they had
previously had a mammogram or breast x-ray Women from high-income
countries were 8.8 times more likely than women from low-income
countries to have reported having a mammogram Additionally, women
in middle-income countries were twice as likely to have had a
mammogram than women in low-income countries Previous cancer
screening Slide 42 Slide 43 Females were asked Have you ever had a
cancer screening test, blood test, or some other test for cancer?
If respondents replied yes, they were asked if they had previously
had a mammogram or breast x-ray In high-income countries,
two-thirds of women aged 50+ report having had a mammogram, as do
half of those aged 40-49 years Mammograms are infrequent in
low-income countries, whereas in middle-income countries, just
under one-quarter of those aged 50+ report having had one Previous
cancer screening Slide 44 Slide 45 Cancer diagnosis Individuals
were asked Have you ever been diagnosed with cancer? and responded
either Yes, No, Dont know or Refused (to respond) In high-income
countries, 10% had been diagnosed with cancer, in comparison to 1%
of other respondents A further 7% of respondents in low-income
countries did not know if they had been diagnosed with cancer Slide
46 Cancer diagnosis Slide 47 Individuals were asked Has anyone in
your immediate family ever been diagnosed with cancer? and
responded either Yes, No, Dont know or Refused (to respond) In low-
and middle-income countries, the majority did not report a
diagnosis in their immediate family In contrast, half of
high-income respondents indicated that an immediate family member
had been diagnosed with cancer Cancer diagnosis Slide 48 Slide 49
Beliefs about a cancer cure To assess beliefs about a cure for
cancer, individuals were asked, Some people believe once a person
has cancer not much can be done to cure it - do you agree or
disagree with that? Individuals then indicated agreement,
disagreement or whether they were undecided Items were reverse
scored for reporting More of those in high-income countries
believed much could be done to cure cancer than those in middle-
and low-income countries When they become available, cancer
screening programmes in low- and middle-income countries will need
to overcome these low expectations of the success of cancer
treatment, which serve as a barrier to screening participation
Slide 50 Beliefs about a cancer cure Slide 51 Medical treatment
decision expectations Respondents were asked When making a decision
about what medical treatment to have, what is your preference?
Response categories were: The doctor should make the decisions
using all that is known about treatment The doctor should make the
decisions but strongly consider your needs and priorities The
doctor and you should make the decisions together on an equal basis
You should make the decisions, but would strongly consider the
doctors opinion You should make the decisions using all you know or
learn about the treatments Cant say Slide 52 Respondents were asked
When making a decision about what medical treatment to have, what
is your preference? The two You should make categories were
combined for scoring and reporting Most respondents in low-income
countries preferred the doctor to make the decisions based on
treatment knowledge Those in middle-income countries had a more
even spread of views about the relative responsibilities of the
doctor or the patient in treatment decisions However, for
respondents in high-income countries, decision- making that allows
for more self-determination was preferred Medical treatment
decision expectations Slide 53 Slide 54 Cancer prevention beliefs
Most important health issues Perceptions of cancer causes and
risks: Drinking tap water from this area Chewing tobacco Drinking
alcohol Not eating vegetables Not eating fruit A lack of cereals or
wholegrains Eating fatty foods Eating red meat Being stressed
Smoking cigarettes A lack of exercise Being overweight Using
mobile/cell phones Exposing your skin to the sun Exposure to air
pollution Infection with viruses/bacteria Slide 55 Important health
issues Respondents were asked Which three health issues do you
consider most important? The majority of those in middle- and
high-income countries identified cancer as an important health
issue In low-income countries, AIDS was the most frequently cited
important health issue Thirty seven percent of those in high-income
countries also identified heart disease as an important health
issue Slide 56 Important health issues Slide 57 Perceived cancer
risk Respondents were asked to indicate if they believed drinking
tap water from their area increases a persons risk of cancer or not
The majority of respondents in all countries believed that drinking
tap water was not a risk 28% of low-income respondents indicated
that they cannot say if drinking tap water in their area increases
a persons risk of cancer or not Slide 58 Perceived cancer risk
Slide 59 Respondents were asked to indicate if they believed
smoking cigarettes increases a persons risk of cancer or not Ninety
percent of those in middle-income and 94% of those in high-income
countries believed that smoking cigarettes increased the risk of
cancer In low-income countries, 69% believed that smoking
cigarettes increased the risk of cancer, but nearly one-quarter
could not say, suggesting that public education appears needed in
low- income countries Perceived cancer risk Slide 60 Slide 61
Respondents were asked to indicate if they believed chewing tobacco
increases a persons risk of cancer or not The majority of
respondents believed that chewing tobacco increases the risk of
cancer However, 31% of those in middle-income countries did not
believe that chewing tobacco increases the risk of cancer Further,
27% of those in low-income countries could not say if chewing
tobacco increases the risk of cancer. Slide 62 Perceived cancer
risk Slide 63 Respondents were asked to indicate if they believed
drinking alcohol increases a persons risk of cancer or not As the
income status of countries increased, there was an increasing
percentage of people who thought that alcohol did not elevate
cancer risk Perceived cancer risk Slide 64 Slide 65 Respondents
were asked to indicate if they believed not eating vegetables
increases a persons risk of cancer or not As the income status of
countries increased, there was an increasing percentage of people
who thought that not eating vegetables elevated cancer risk
Perceived cancer risk Slide 66 Slide 67 Respondents were asked to
indicate if they believed not eating fruit increases a persons risk
of cancer or not As the income status of countries increased, there
was an increasing percentage of people who thought that not eating
fruit elevated cancer risk Slide 68 Perceived cancer risk Slide 69
Respondents were asked to indicate if they believed a lack of
cereals and wholegrains increases a persons risk of cancer or not
As the income status of countries increased, there was an
increasing percentage of people who thought that a lack of cereals
and grains elevated cancer risk Perceived cancer risk Slide 70
Slide 71 Respondents were asked to indicate if they believed eating
fatty foods increases a persons risk of cancer or not As the income
status of countries increased, there was an increasing percentage
of people who thought that eating fatty foods elevated cancer risk
Perceived cancer risk Slide 72 Slide 73 Respondents were asked to
indicate if they believed eating red meat increases a persons risk
of cancer or not In comparison to those in low-income countries, a
greater percentage of those in middle- and high-income countries
thought eating red meat elevated cancer risk A higher percentage in
all countries thought eating red meat did not elevate cancer risk
Perceived cancer risk Slide 74 Slide 75 Respondents were asked to
indicate if they believed a lack of exercise increases a persons
risk of cancer or not As the income status of countries increased,
there was an increasing percentage of people who thought that a
lack of exercise elevated cancer risk Perceived cancer risk Slide
76 Slide 77 Respondents were asked to indicate if they believed
being overweight increases a persons risk of cancer or not As the
income status of countries increased, there was an increasing
percentage of people who thought that being overweight elevated
cancer risk Perceived cancer risk Slide 78 Slide 79 Respondents
were asked to indicate if they believed using a mobile phone
increases a persons risk of cancer or not As the income status of
countries increased, there was an increasing percentage of people
who thought that using mobile or cell phones did not elevate cancer
risk Perceived cancer risk Slide 80 Slide 81 Respondents were asked
to indicate if they believed exposing your skin to the sun
increases a persons risk of cancer or not As the income status of
countries increased, there was an increasing percentage of people
who thought that exposing your skin to the sun elevated cancer risk
Perceived cancer risk Slide 82 Slide 83 Respondents were asked to
indicate if they believed exposure to air pollution increases a
persons risk of cancer or not Those in middle- and high-income
countries were more likely than those in low-income countries to
think that air pollution elevated cancer risk Perceived cancer risk
Slide 84 Slide 85 Respondents were asked to indicate if they
believed infection with viruses or bacteria increases a persons
risk of cancer or not Those in middle- and high-income countries
were more likely than those in low-income countries to think that
infection with viruses or bacteria elevated cancer risk Perceived
cancer risk Slide 86 Slide 87 Respondents were asked to indicate if
they believed being stressed increases a persons risk of cancer or
not Those in middle- and high-income countries were more likely
than those in low-income countries to think that being stressed
elevated cancer risk Perceived cancer risk Slide 88 Slide 89
Tobacco use and perceived cancer risk of smoking cigarettes Tobacco
use and perceived cancer risk of chewing tobacco Alcohol
consumption and perceived cancer risk of drinking alcohol Sunburn
in the last 12 months and perceived cancer risk of sun exposure
Body mass index and perceived cancer risk of being overweight Level
of physical activity and perceived cancer risk of a lack of
exercise Cancer risk factors and prevention beliefs Slide 90 In all
countries, a smaller percentage of tobacco users thought cigarettes
elevated cancer risk, compared with those who did not consume
tobacco This relative difference narrowed between those who did and
did not consume tobacco as the income level of countries increased
Cancer risk factors and prevention beliefs Slide 91 Slide 92 As
income status increased, there was an increasing percentage of
tobacco users who believed that smoking cigarettes increases cancer
risk Twenty-four percent of low-income country tobacco users could
not say if smoking cigarettes increases the risk of cancer or not
Cancer risk factors and prevention beliefs Slide 93 Slide 94 In all
countries, a smaller percentage of tobacco users thought chewing
tobacco elevated cancer risk, compared with those who did not
consume tobacco Over one-third of middle-income tobacco users
believed that chewing tobacco was not a cancer risk in comparison
to 12% of tobacco users in high-income countries and 19% of tobacco
users in low-income countries Cancer risk factors and prevention
beliefs Slide 95 Slide 96 In high-income countries, tobacco users
were more likely than low- or middle-income tobacco users to
believe that chewing tobacco increases the risk of cancer Over one
quarter of tobacco users in low-income countries indicated that
they cant say whether chewing tobacco increases a persons cancer
risk Cancer risk factors and prevention beliefs Slide 97 Slide 98
Within each income category, those who more often drank alcohol
were less likely to perceive that alcohol increased cancer risk Of
note, 52% of frequent drinkers in high-income countries and 49% of
frequent drinkers in middle-income countries believed there was no
cancer risk associated with drinking alcohol Cancer risk factors
and prevention beliefs Slide 99 Slide 100 As income status
increased, the percentage of frequent drinkers who believed that
there was no cancer risk associated with drinking alcohol increased
In addition, in the low-income category 45% of frequent drinkers
could not say whether drinking alcohol increases a persons risk of
cancer Cancer risk factors and prevention beliefs Slide 101 Slide
102 As the income status of countries increased, there was an
increasing percentage of people who thought that exposing ones skin
to the sun elevated cancer risk Cancer risk factors and prevention
beliefs Slide 103 Slide 104 In all countries, individuals who did
and did not report being sunburnt had similar perceptions of the
cancer risk associated with exposing ones skin to the sun Cancer
risk factors and prevention beliefs Slide 105 Slide 106 As income
status increased, an increasing percentage of respondents believed
that being overweight increases the risk of cancer High- and
middle-income overweight/obese respondents were over 3 times more
likely to perceive being overweight as increasing the risk of
cancer than overweight/obese individuals from low-income countries
Cancer risk factors and prevention beliefs Slide 107 Slide 108
Overweight/obese respondents from high- and middle-income countries
were over 3 times more likely to perceive being overweight as
increasing the risk of cancer than overweight/obese individuals
from low-income countries Cancer risk factors and prevention
beliefs Slide 109 Slide 110 Further enquiries? Unit-record-level
data is available for further data analysis by the UICC member
organization, provided it is not sold on to any third party. Visit
www.cancervic.org.au/uicc for more detailed graphs on all the data
items by World Bank income category or email
[email protected]/uicc
[email protected] Future analyses will be
posted to this website in the coming months
