{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T02:29:41Z","timestamp":1740104981125,"version":"3.37.3"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,10,19]],"date-time":"2017-10-19T00:00:00Z","timestamp":1508371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Cancer Research UK Early Diagnosis Advisory Group","award":["C33872\/A18555"],"award-info":[{"award-number":["C33872\/A18555"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Socioeconomic inequalities in recognising signs and symptoms of cancer may result in inequalities in timely help\u2010seeking and subsequent prognosis of breast cancer. We explored the mediating role of symptom attribution and concern on the relationship between level of education and help\u2010seeking for potential breast cancer symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women aged \u226547\u00a0years (n\u00a0=\u00a0961) were purposively recruited (by education) to complete an online vignette\u2010based survey that included nipple rash and axillary lump (in separate vignettes) as potential symptoms of breast cancer. Women completed questions relating to medical help\u2010seeking (yes\/no), cancer attribution, symptom concern, cancer avoidance, family history, and demographics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Women with low education and mid education attributed nipple rash less often to cancer (26% and 27% mentioned cancer) than women with a degree or higher (40%). However, women with a degree or higher (63%) or mid education (64%) were less likely to anticipate seeking help for the nipple rash than women with no formal qualifications (73%). This association was statistically significant in the 60\u2010 to 69\u2010year\u2010old age group. There was no significant association between education and help\u2010seeking for axillary lump. Mediation analysis adjusting for potential confounders confirmed that the association between education and help\u2010seeking for nipple rash was fully mediated by symptom concern.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Socioeconomic inequalities in stage at diagnosis and survival of breast cancer may not always be explained by lower likelihood of suspecting cancer and subsequent impact on help\u2010seeking. Reducing inequalities in stage at diagnosis will involve understanding a broader range of bio\u2010psycho\u2010social factors (eg, comorbidities and healthcare system factors).<\/jats:p><\/jats:sec>","DOI":"10.1002\/pon.4557","type":"journal-article","created":{"date-parts":[[2017,9,20]],"date-time":"2017-09-20T17:22:40Z","timestamp":1505928160000},"page":"626-632","source":"Crossref","is-referenced-by-count":12,"title":["Is lower symptom recognition associated with socioeconomic inequalities in help\u2010seeking for potential breast cancer symptoms?"],"prefix":"10.1002","volume":"27","author":[{"given":"Hilary","family":"Davies","sequence":"first","affiliation":[{"name":"School of Health Sciences University of Surrey  Guildford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afrodita","family":"Marcu","sequence":"additional","affiliation":[{"name":"School of Health Sciences University of Surrey  Guildford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Vedsted","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP) Faculty of Health, Aarhus University  Aarhus Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0947-1840","authenticated-orcid":false,"given":"Katriina L.","family":"Whitaker","sequence":"additional","affiliation":[{"name":"School of Health Sciences University of Surrey  Guildford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,10,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)02143-1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1865-x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28221"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2012.126-c1"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605398"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605386"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.07.014"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4177"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1972-8"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.684"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-006-9059-2"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)02142-X"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.2038"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2008.02564.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-09-0997"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2011.87"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-7435(02)00053-1"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X682873"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjhp.12215"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/13591053030083006"},{"key":"e_1_2_7_22_1","unstructured":"Cancer Research UK.Breast screeninghttp:\/\/wwwcancerresearchukorg\/about\u2010cancer\/breast\u2010cancer\/screening\/breast\u2010screening.2017;Last accessed 11\/08\/2017."},{"key":"e_1_2_7_23_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-001758","article-title":"An international measure of awareness and beliefs about cancer: development and testing of the ABC","volume":"2","author":"Simon AE","year":"2012","journal-title":"BMJ Open"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.01.022"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0110262"},{"key":"e_1_2_7_26_1","first-page":"322","volume-title":"Essential Medical Statistics","author":"Kirkwood B","year":"2003"},{"key":"e_1_2_7_27_1","first-page":"215","volume-title":"Selected Papers of Hirotugu Akaike","author":"Akaike H","year":"1998"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.445"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1006\/jmps.1999.1276"},{"key":"e_1_2_7_30_1","unstructured":"KennyDA.Mediation with dichotomous outcomes. Available from: file:\/\/homessurreyacuk\/home\/downloads\/dichmedpdf Last accessed 07\/04\/2017.2013."},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114028"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-13-21"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-636"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-11-0437"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-597"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdj007"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29983"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmm049"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/14.3.311"},{"key":"e_1_2_7_40_1","article-title":"Do comorbidities influence help\u2010seeking for cancer alarm symptoms? A population\u2010based survey in England","author":"Salika S","year":"2017","journal-title":"J Public Health"}],"container-title":["Psycho-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpon.4557","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pon.4557","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T07:47:29Z","timestamp":1695541649000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pon.4557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,19]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1002\/pon.4557"],"URL":"https:\/\/doi.org\/10.1002\/pon.4557","archive":["Portico"],"relation":{},"ISSN":["1057-9249","1099-1611"],"issn-type":[{"type":"print","value":"1057-9249"},{"type":"electronic","value":"1099-1611"}],"subject":[],"published":{"date-parts":[[2017,10,19]]}}}