Introduction
The time between first noticing a symptom to consultation in primary care is the most delaying factor in the diagnostic pathway of oesophageal cancer. Non-recognition of symptom severity is the predominant factor in delayed help-seeking and can be modified through education. Understanding the general public’s awareness of oesophageal cancer symptoms and the differences among population subgroups is important for developing targeted education campaigns.
Aims & Methods
We performed a population-wide survey assessing awareness of oesophageal cancer symptoms and anticipated time to help-seeking for dysphagia. Individuals aged 18-75 years were selected from the Dutch population registry using simple random sampling (n=3270 respondents). Items adapted from the Awareness and Beliefs about Cancer measure and Cancer Awareness Measure were administered. Disparities in oesophageal cancer symptom awareness among socio-demographic subgroups (e.g., based on age, gender, education, migration background, civil status, and socio-economic status) were examined using chi-square analyses.
Results
When open (unprompted) questions were used, only 11% of the participants listed dysphagia as an oesophageal cancer symptom and the majority (60%) did not list any correct symptom. The proportion that recognized dysphagia as a potential cancer symptom was higher (48%) with closed (prompted) questions but remained poor compared with symptoms of other cancer types (change in bowel or bladder habits: 78%; change in the appearance of a mole: 94%; unexplained breast lump or swelling: 93%). Low oesophageal cancer symptom awareness was significantly associated with male gender (p<0.001), lower education (p<0.001), living in a deprived neighbourhood (p=0.010), and non-western migration background (p=0.002). Knowing someone with oesophageal cancer was associated with higher awareness (p<0.001). No associations were found between oesophageal cancer awareness and age or civil status. Anticipated late help-seeking for dysphagia was more common among participants who did not associate the symptom with cancer (15% would consult after 1 month) than among those who did (11% would consult after 1 month) (p<0.001).
Conclusion
Our findings demonstrate a disconcertingly low public awareness of oesophageal cancer symptoms. Targeted education campaigns to improve recognition of dysphagia as a potential symptom of oesophageal cancer may improve earlier help-seeking.
Disclosure
PS is receiving unrestricted grants from Pentax (Japan), Norgine (UK), Motus GI (USA), MicroTech (China) and The eNose Company (Netherlands) and is in the advisory board of Motus GI (USA) and Boston Scientific (USA). All other authors declare no competing interests.