Introduction

Cancer is recognized as an essential health problem worldwide and is the second leading cause of death in the United States of America.^[1] The burden of cancer continues to increase globally, putting significant physical, emotional, and financial pressure on individuals, families, communities, and health systems. In countries with robust health systems, survival rates for many types of cancer can be increased through accessible early diagnosis, quality treatment, and survivorship care.^[2] In order to achieve early diagnosis and thus prolong the life span of patients, it is necessary to increase the level of awareness, consciousness, and knowledge of society about cancer and screening programs. In a study conducted on awareness levels, poor cancer awareness was shown to be an essential reason for lower survival and higher mortality rates, especially among the black American population. It has been stated that low awareness leads to worse outcomes because people present to the medical care system when they are in the advanced stage of cancer.^[3] Therefore, to increase awareness, practices that may lead to an increase in the belief levels of society towards cancer should be put forward, and the groups at risk should be directed to screening programs by raising awareness of society by health authorities. However, it is also possible to come across studies indicating various barriers to participation in cancer screening programs. Studies are showing that cultural factors such as knowledge, beliefs, and attitudes about cancer disease or screening process, lack of health insurance, communication problems, distrust in the health system, and fatalistic beliefs may prevent participation in cancer screening programs.^[4] As a result of the literature review, it is possible to find studies showing that studies' beliefs about cancer are more directive and may affect patients' cancer awareness and participation in screening programs. For example, in a study conducted with 108 patients, participants' cognitive and emotional beliefs about lung cancer were evaluated. Self-reporting served to gauge the intention to undergo lung cancer screening with a CT scan. Fatalistic beliefs, fear of radiation exposure, and anxiety about CT scans were found to be significantly associated with decreased intention to screen. It was found that
 

differences were observed in the beliefs of minority and non-minority participants about lung cancer and screening.^[5]

It is known that various cognitive, emotional, and cultural factors affect belief. Considering that there is a close relationship between belief and action, the relationship between beliefs about cancer, awareness, and screening programs was addressed within the scope of the study. The relationship between these variables was tried to be explicitly revealed for cancer patients.

Materials and Methods

The materials and methods used within the scope of the research are to be explained in the form of sub-headings. Such a way was followed due to the complexity of the method used.

Study setting and timing

This study was conducted from March 7 – November 8, 2022, to obtain 7,000 completed questionnaires in the United States of America by the National Cancer Institute (NCI). The population of this study is Americans who participated in the Health Information National Trends Survey (HINTS) conducted by the NCI.^[6]

Study design

This study was conducted using a descriptive cross-sectional type. The model of the study is the relational screening model, a causal comparison subtype of quantitative research methods. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement’s guidelines for reporting cross-sectional studies (Table 1).

*Give information separately for cases and controls in case-control studies and, if applicable, for exposed and unexposed groups in cohort and cross-sectional studies.

Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is available at www.strobe-statement.org

Participants

Participants were civilian, noninstitutionalized, aged 18 and over, living adults in the United States who participated in the HINTS survey conducted by the NCI.

Sample size and sampling

The sampling strategy for the HINTS 6 survey consisted of a two-stage design. In the first stage, a stratified sample of addresses was selected from a file of residential addresses. In the second stage, one adult was selected within each sampled household. With this two-stage sampling, the sample size of 6252 people was determined.

Data collection tools

The data were collected with the HINTS 6 survey by NCI, published in 2023. Questions in the HINTS 6 survey, such as gender, age, full-time employment status, occupation, marital status, education level, ethnicity, income range, perceived income level, frequency of going to health institutions, and general health status, were used to collect findings regarding the demographic information of the participants. Questions such as lung cancer, cervical cancer, colorectal cancer, and HPV knowledge were used to collect findings regarding the participants' cancer screening and awareness levels. In addition, findings regarding the participants' beliefs about cancer were reported regarding the question of the possibility of getting cancer.

Data analysis

Frequency and percentage values were used to report demographic and other discrete variables. Pearson Correlation Coefficient was used for correlation analysis. All analyses employed a two-sided p-value < 0.05 at a 95% confidence level. All analyses were performed with Jamovi Version 2.4 computer software.^{[7, 8]}

Ethical consideration and responsibilities

Ethical approval and participant consent were not required as this study involved publicly available de-identified data.

Results and Discussion

The majority of the participants were women; the number of people working full time was less than those who were not working; the majority of them were working and retired, the majority of them were married, college graduates, and not only Hispanic; the majority of them had an annual income between 100 thousand and 200 thousand dollars and live comfortably with their current income. It was determined that the majority of them receive service from health institutions at least twice a year. Their general health condition is good or excellent (Table 2).

A large portion of participants reported not speaking to a healthcare professional to check for lung cancer. On the other hand, 18.4 percent of female participants reported having had a Pap test for cervical cancer in the last year or more recently. Most participants stated that a physician or healthcare professional informed them that several tests were available to detect colorectal cancer. The majority of the participants stated that they had heard of HPV and thought that it caused cervical cancer and that they also had information about the cervical cancer vaccine or HPV shot (Table 3).

Most of the participants marked "neither likely nor unlikely" for their risk of getting cancer compared to their peers (Table 4).

InterestedCaScreening: Interested in having a cancer screening test in the next year; FreqWorryCancer: Worried about getting cancer; P3_Total: Everything causes cancer, prevention not possible, too many recommendations, cancer fatal; P4_Total: Increase cancer soda sugar, Increase cancer alcohol; P5_Total: Increase cancer too much-processed meat, Increase cancer too much red meat, Increase cancer too much fast food, Not eating enough fruits and vegetables, Not getting enough sleep; P6_Total: Cancer progress prevention, cancer progress cures.

It seemed that very few of the participants had cancer, and almost one in two were interested in cancer screening tests. Very few of the participants are worried about getting cancer. It was determined that the majority of the participants believe that everything causes cancer, that it is unpreventable, that there are many recommendations for cancer, and that cancer is a fatal disease. Many participants stated that soda, sugar, alcohol use, too much processed meat, too much red meat, too much fast food, not eating enough fruits and vegetables, and not getting enough sleep increased cancer (Table 5).

* p<0.05; **p<0.01; ***p<0.001; InterestedCaScreening: Interested in having a cancer screening test in the next year; FreqWorryCancer: Worried about getting cancer; P3_Total: Everything cause cancer, prevent not possible, too many recommendations, cancer fatal; P4_Total: Increase cancer soda sugar, Increase cancer alcohol; P5_Total: Increase cancer too much-processed meat, Increase cancer too much red meat, Increase cancer too much fast food, Not eating enough fruits and vegetables, Not getting enough sleep; P6_Total: Cancer progress prevention, cancer progress cures.

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