Cancer fatalism: deterring early presentation and increasing social inequalities?

Abstract

Background: Fatalistic beliefs about cancer have been implicated in low uptake of screening and delay in presentation particularly in low socioeconomic status (SES) groups, but no studies have systematically evaluated interrelationships between SES, fatalism, and early detection behaviors. We explored whether (i) fatalism is associated with negative attitudes toward early detection, (ii) lower SES groups are more fatalistic, and (iii) SES differences in fatalism partly explain SES differences in attitudes toward early detection.

Methods: In a population-representative sample of adults in Britain using computer-based interviews in the home setting, respondents (N = 2,018) answered two questions to index fatalism (expectations of cancer survival and cure) and two items on early detection attitudes (the perceived value of early detection and fear of symptom reporting). SES was indexed with a social grade classification.

Results: Fatalism was associated with being less positive about early detection (β = -0.40, P < 0.001) and more fearful about seeking help for a suspicious symptom (β = 0.24, P < 0.001). Lower SES groups were more fatalistic (β = -0.21, P < 0.001). Path analyses suggest that SES differences in fatalism might explain SES differences in attitudes about early detection.

Conclusions: In this population sample, SES differences in fatalism partly explained SES differences in the perceived value of early detection and fear of symptom presentation.

Impact: Fatalistic beliefs about cancer should be targeted to promote early presentation of cancer and this may be particularly important for lower SES groups.

Figure 1

Path model for the relationship between SES, fatalism and fear of reporting symptoms/perceived value of early detection. Standardised coefficients reported. Residuals were estimated but are not included in the diagram for ease of reading, ***=p<.001