Awareness of symptoms, anticipated barriers and delays to help-seeking among women at higher risk of breast cancer: a UK multicentre study

Background: Women with a family history of breast cancer have an increased lifetime risk of the disease. Delay in symptom presentation can lead to poorer outcomes. Low awareness of breast cancer symptoms and help-seeking barriers have been associated with delay in presentation in the general population. Symptom awareness and help-seeking barriers among women at increased risk of breast cancer are unknown. Methods: We conducted a secondary analysis of survey data which included women with moderate and high risk of breast cancer from 20 secondary and tertiary care clinics in England (n=408). Women completed a validated survey assessing breast cancer symptom awareness, barriers to help-seeking and anticipated delay in help-seeking. Results: Women recognised an average of 9.1/11 breast cancer symptoms (SD=2.1). Nipple rash was the least recognised symptom (51.0%). Women educated to at least degree level had higher awareness than those with lower education (β= 0.14, 95% CI 0.13, 0.99, p = 0.011). Women at lower socioeconomic status (SES) had lower awareness than those at higher SES (β= -0.13, 95% CI -1.09, -0.07, p=0.027). Women reported several anticipated help-seeking barriers (mean=4.0/11, SD=2.8). Most women (376/408; 92.2%) reported that they would seek medical help within 2 weeks of discovering a breast cancer symptom. Conclusion: Interventions to increase awareness of non-lump breast cancer symptoms and reduce help-seeking barriers are needed, particularly in less educated and more deprived women.