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What do European women know about their female cancer risks and cancer screening? A cross-sectional online intervention survey in five European countries
  1. Odette Wegwarth1,2,
  2. Martin Widschwendter3,
  3. David Cibula4,
  4. Karin Sundström5,6,
  5. Rosalba Portuesi7,8,
  6. Ines Lein2,
  7. Felix G Rebitschek2
  8. on behalf of the FORECEE (4C) consortium
  1. 1 Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
  2. 2 Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
  3. 3 Department of Women’s Cancer, University College London, London, UK
  4. 4 Department of Obstetrics and Gynecology, Charles University Prague (Czech Republic), Prague, UK
  5. 5 Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
  6. 6 Laboratory Karolinska University Hospital, Karolinska University, Stockholm, Sweden
  7. 7 Unit of Gynecology, Humanitas Research Hospital, Milan, Italy
  8. 8 Unit of Preventive Gynecology, European Institute of Oncology, Milan, Italy
  1. Correspondence to Dr Odette Wegwarth; wegwarth{at}


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.

  • risk literacy
  • patient education
  • breast cancer
  • gynecological cancers

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  • Contributors Study concept and design: OW and FGR; acquisition of data: all authors; analysis of data: OW and FGR; interpretation of data: all authors; drafting of the manuscript: OW; critical revision of the manuscript for important intellectual content: all authors; statistical expertise: OW and FGR; study supervision: OW, MW and FGR. Final approval of the submitted version of the manuscript: all authors.

  • Funding 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; 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.

  • Disclaimer The funding organisations had no role in the design, conduct, collection, analysis and interpretation of the data and no role in the preparation, review or approval of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Institutional Ethics Board of the Max Planck Institute for Human Development, Berlin (Germany).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Collaborators FORECEE (4C) consortium members: Prof. Joakim Dillner, Dr. Michal Zikan, Dr. Line Bjorge, Prof. Nicoletta Colombo, Dr. Richard Hadwin, Prof. Nadia Harbeck, Prof. Frank Dudbridge, Prof. Ewout Steyerberg, Prof. Inez de Beaufort, Prof. Uwe Siebert, Dr. Gaby Sroczynski, Dr. Andreas Leimbach, Dr. Tobias Paprotka, Ms. Allison Jones

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