{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:45:41Z","timestamp":1787013941151,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,9,29]],"date-time":"2016-09-29T00:00:00Z","timestamp":1475107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C33872\/A18555"],"award-info":[{"award-number":["C33872\/A18555"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["British J Health Psychol"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Advanced stage at diagnosis for breast cancer is associated with lower socio\u2010economic status (\n                      <jats:styled-content style=\"fixed-case\">SES<\/jats:styled-content>\n                      ). We explored what factors in the patient interval (time from noticing a bodily change to first consultation with a health care professional) may contribute to this inequality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative comparative study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Semi\u2010structured interviews with a sample of women (\u226547\u00a0years) from higher (\n                      <jats:italic>n\u00a0<\/jats:italic>\n                      =\n                      <jats:italic>\u00a0<\/jats:italic>\n                      15) and lower (\n                      <jats:italic>n\u00a0<\/jats:italic>\n                      =\n                      <jats:italic>\u00a0<\/jats:italic>\n                      15) educational backgrounds, who had experienced at least one potential breast cancer symptom. Half the participants (\n                      <jats:italic>n\u00a0<\/jats:italic>\n                      =\n                      <jats:italic>\u00a0<\/jats:italic>\n                      15) had sought medical help, half had not (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a015). Without making breast cancer explicit, we elicited women's sense\u2010making around their symptoms and help\u2010seeking decisions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Containment of symptoms and confidence in acting upon symptoms emerged as two broad themes that differentiated lower and higher educational groups. Women from lower educational backgrounds tended to attribute their breast symptoms to trivial factors and were reticent in using the word \u2018cancer\u2019. Despite \u2018knowing\u2019 that symptoms could be related to cancer, women with lower education invoked lack of medical knowledge \u2013 \u2018\n                      <jats:italic>I am not a doctor\u2019<\/jats:italic>\n                      \u2013 to express uncertainty about interpreting symptoms and accessing help. Women with higher education were confident about interpreting symptoms, seeking information online, and seeking medical help.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that knowledge of breast cancer alone may not explain socio\u2010economic differences in how women respond to breast cancer symptoms as women with lower education had \u2018reasons\u2019 not to react. Research is needed on how to overcome a wider spectrum of psycho\u2010social factors to reduce future inequality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Statement of contribution<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:italic>\n                            <jats:bold>What is already known on this subject?<\/jats:bold>\n                          <\/jats:italic>\n                        <\/jats:p>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>Seven of ten breast cancers in the UK are diagnosed after people contact their doctor with symptoms.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Women from lower socio\u2010economic backgrounds are more likely to be diagnosed with advanced disease.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>There is little evidence related to potential drivers of this SES inequality.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                        <jats:p>\n                          <jats:italic>\n                            <jats:bold>What does this study add?<\/jats:bold>\n                          <\/jats:italic>\n                        <\/jats:p>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>We qualitatively explored socio\u2010economic (SES) differences in help\u2010seeking for breast symptoms.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Women with higher education were more confident about interpreting symptoms and navigating health care.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Women with lower education were more reluctant to seek help due to fear of cancer.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  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