e023789.full.pdf (888.42 kB)
Download file

What do European women know about their female cancer risks and cancer screening? A cross-sectional online intervention survey in five European countries

Download (888.42 kB)
journal contribution
posted on 01.05.2019, 08:51 by O Wegwarth, M Widschwendter, D Cibula, K Sundstroem, R Portuesi, I Lein, FG Rebitschek, J Dillner, M Zikan, L Bjorge, N Colombo, R Hadwin, N Harbeck, F Dudbridge, E Steyerberg, I de Beaufort, U Siebert, G Sroczynski, A Leimbach, T Paprotka, A Jones
Objectives Informed decisions about cancer screening require accurate knowledge regarding cancer risks and screening. This study investigates: (1) European women’s knowledge of their risk of developing breast, ovarian, cervical or endometrial cancer, (2) their knowledge about mammography screening and (3) whether an evidence-based leaflet improves their knowledge. Design Cross-sectional online intervention survey. Setting National samples from five European countries (Czech Republic, Germany, UK, Italy and Sweden)—drawn from the Harris Interactive and the Toluna panel, respectively, in January 2017—were queried on their knowledge of age-specific risks of developing breast, cervical, ovarian or endometrial cancer within the next 10 years and of mammography screening before and after intervention. Participants Of 3629 women (inclusion criteria: age 40–75 years) invited, 2092 responded and 1675 completed the survey (response rate: 61.4%). Intervention Evidence-based leaflet summarising information on age-adjusted female cancer risks, mammography and aspects of cancer prevention. Primary outcome measures Proportion of women (1) accurately estimating their risk of four female cancers, (2) holding correct assumptions of mammography screening and (3) changing their estimations and assumptions after exposure to leaflet. Findings Across countries, 59.2% (95% CI 56.8% to 61.6%) to 91.8% (95% CI 90.3% to 93.0%) overestimated their female cancer risks 7–33 fold (mediansacross tumours: 50.0 to 200.0). 26.5% (95% CI 24.4% to 28.7%) were aware that mammography screening has both benefits and harms. Women who accurately estimated their breast cancer risk were less likely to believe that mammography prevents cancer (p<0.001). After leaflet intervention, knowledge of cancer risks improved by 27.0 (95% CI 24.9 to 29.2) to 37.1 (95% CI 34.8 to 39.4) percentage points and of mammography by 23.0 (95% CI 21.0 to 25.1) percentage points. Conclusion A considerable number of women in five European countries may not possess the prerequisites for an informed choice on cancer screening. Evidence-based information in patient leaflets can improve this situation.


The work was funded by the European Union’s Horizon 2020 research and innovation project: Female cancer prediction using cervical omics to individualise screening and prevention (FORECEE; grant agreement number: 634570; https://forecee.eu/). MW’s contributions were undertaken at University College London Hospitals/University College London, which received a proportion of its funding from the Department of Health NIHR Biomedical Research Centres funding scheme. Guarantor of the manuscript: OW.



BMJ Open, 2018, 8:e023789

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences


VoR (Version of Record)

Published in

BMJ Open


BMJ Publishing Group



Acceptance date


Copyright date


Available date


Publisher version



The full dataset is available to researchers via an application to the FORECEE (4C) consortium group.