In UK, ‘stiff upper lip’ hurts cancer survival

KING’S COLLEGE LONDON / UCL (UK) — Cultural factors may explain some of the differences in cancer survival rates between the UK and other high-income countries.

A new study published in the British Journal of Cancer shows factors such as embarrassment and not wanting to waste a doctor’s time may hold British people back from seeking early medical advice for symptoms of cancer.

The study is part of the International Cancer Benchmarking Partnership (ICBP), which has previously found that for lung, breast, bowel, and ovarian cancers diagnosed between 1995 and 2007, Australia, Canada, Sweden, and Norway had the highest rates of survival, and Denmark and UK the lowest, despite all the countries having similarly good cancer registration systems and good access to health care.


For example, in the UK, the one year survival rate of those diagnosed with lung cancer between 2005 and 2007 was 30 percent, compared to 44 percent in Sweden. Researchers wanted to find out whether survival rates for a country might be influenced by the population’s cancer awareness and beliefs.

In partnership with Cancer Research UK and Ipsos MORI, the team surveyed 19,079 men and women 50 and older in Australia (4,002 individuals), Canada (2,064), Denmark (2,000), Norway (2,009), Sweden (2,039), and the UK (6,965).

There was little difference in awareness of cancer symptoms and beliefs about cancer outcomes between the countries. However, the study revealed significant differences in people’s barriers to symptomatic presentation.

Being worried about wasting the doctor’s time was particularly common in the UK (34 percent) and least common in Sweden (9 percent). Embarrassment about going to the doctor with a symptom that might be serious was most commonly reported in the UK (15 percent) and least in Denmark (6 percent).

The study also found that awareness of the risk of cancer being higher in older people varied significantly across countries, being lowest in Canada (13 percent) and the UK (14 percent) and highest in Sweden (38 percent).

“The UK stood out in this study,” says Lindsay Forbes, from the Promoting Early Presentation Group at King’s College London and joint lead author of the study. “A high proportion of people said that not wanting to waste the doctor’s time and embarrassment might stop them going to the doctor with a symptom that might be serious.

“The traditional British ‘stiff upper lip’ could be preventing people from seeing their doctor. We need to support people to make the right decisions about their health and increase awareness of the age-related risk.”

Professor Jane Wardle from University College London adds: “In the UK, it’s important to understand more about how people make the decision to go to their GP with possible cancer symptoms, and how they interact with their GP, to identify the best ways to reduce barriers to early presentation.”

The study was funded by the UK’s Department of Health, with additional funding from the National Cancer Action Team (UK), Northern Ireland Public Health Agency (UK), Tenovus and Welsh Government (UK), Cancer Council Victoria (Australia), Department of Health Victoria (Australia), Cancer Institute New South Wales (Australia), Canadian Partnership against Cancer, Danish Cancer Society, Novo Nordic Foundation (Denmark), Norwegian Directorate for Health and Social Affairs, Swedish Social Ministry and the Association of Local Authorities and Regions (Sweden). Program management was provided by Cancer Research UK.

Sources: King’s College London, University College London