Breast Cancer Survey. GfK HealthCare. A study conducted for Siemens Communication Sector, Erlangen. January 2011

Transcription

1 .. Breast Cancer Survey GfK HealthCare A study conducted for Siemens Communication Sector, Erlangen January

2 Agenda Study design Study results in detail Realization of sample Management summary

3 Study design

4 .. Study design and methodology Method: Online survey Interview length: minutes Fully structured questionnaire (including open-ended questions) Target group: n = women between - years of age per country Scope: countries: USA, Germany, Brazil, China, Russia, India, Sweden, Austria Duration of field work: December January

5 .. Scope and Achieved Sample Sizes (I). Europe: Germany n = Sweden n = Austria n =. North America: USA n =. Asia Pacific: China n = India n = Russia n =. Latin America: Brazil n = Total: n =

6 Study results in detail

7 a Breast cancer screening

8 .. a. Breast cancer screening - Importance According to more than three quarters of the women breast cancer screening is perceived as very important. Especially in Brazil almost all women state that breast cancer screening is of high importance. total mean, Scale: = not important = very important USA, Germany, Brazil, China, Russia, India, Sweden, Austria, Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Qa: Would you please tell us how important cancer screening, particularly breast cancer screening, is to you personally?

9 a. Breast cancer screening - Importance Sweden: Age.. total mean, Scale: = not important = very important - years, - years, - years, - years, Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = (Sweden) Qa: Would you please tell us how important cancer screening, particularly breast cancer screening, is to you personally?

10 a. Breast cancer screening - Importance Sweden: Education.. mean Scale: = not important = very important total, Low, Mid, High, Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = (Sweden) Qa: Would you please tell us how important cancer screening, particularly breast cancer screening, is to you personally?

11 .. a. Breast cancer screening Importance (Why) Prevention, early detection and the increase of the chances of recovery are the most often mentioned reasons why breast cancer screening is so important. (Very) important: Importance of prevention/early detection For early detection Prevention To increase chances of recovery For best chance at treatment To stay healthy To be able to react quickly Importance of screening I think it is important In a risk group Family history of breast cancer Aware/afraid of cancer High breast cancer incidence Every woman is at risk Increasing breast cancer awareness Total USA - - Germany - Brazil - China Russia - - India - Sweden - - Open answers Answers % Austria - Overcodes Basis: Subsample (very/ important Qa) n = Qb: Please explain your answer briefly!

12 .. a. Breast cancer screening - Knowledge Overall about % of the women rate their knowledge regarding breast cancer screening as good or very good. Interestingly in India the women feel the best informed. total mean, Scale: = no knowledge = very well informed USA, Germany, Brazil, China, Russia, India, Sweden, Austria, No knowledge Deficient Sufficient Satisfactory Good Very well informed Basis: Total: n = Qc: How would you rate your own knowledge of breast cancer screening?

13 a. Breast cancer screening - Importance Russia: Age.. mean total, Scale: = no knowledge = very well informed - years, - years, - years,, - years No knowledge Deficient Sufficient Satisfactory Good Very well informed Basis: Total: n = (Russia) Qc: How would you rate your own knowledge of breast cancer screening?

14 a. Breast cancer screening - Importance Russia: Education.. mean total, Scale: = no knowledge = very well informed Low, Mid, High, No knowledge Deficient Sufficient Satisfactory Good Very well informed Basis: Total: n = Russia Qc: How would you rate your own knowledge of breast cancer screening?

15 a. Breast cancer screening - Importance Sweden: Age.. mean total, Scale: = no knowledge = very well informed - years, - years, - years,, - years No knowledge Deficient Sufficient Satisfactory Good Very well informed Basis: Total: n = (Sweden) Qc: How would you rate your own knowledge of breast cancer screening?

16 a. Breast cancer screening - Importance Sweden: Education.. mean total, Scale: = no knowledge = very well informed Low, Mid, High, No knowledge Deficient Sufficient Satisfactory Good Very well informed Basis: Total: n = (Sweden) Qc: How would you rate your own knowledge of breast cancer screening?

17 .. a. Breast cancer screening - Usage About two thirds of the women indicate that they have had a breast cancer screening. In Austria and Germany the number is even higher - more than three quarters have had a breast cancer screening. total USA Germany Brazil China Russia India Sweden Austria yes no Can't remember Basis: Total: n = Qa: Have you ever had a breast cancer screening examination before?

18 .. a. Breast cancer screening Reasons for not having a breast cancer screening Overall women who haven't had a breast cancer screening yet, mostly indicate that there are not at risk of getting breast cancer or are not at the age to worry. No breast cancer screening Open answers Answers % Total USA Germany Brazil China Russia India Sweden Austria Not at risk Not at the age to worry No need for a screening I don't think I need it Doctor never recommended it to me Never was advised by a doctor to have one Question of cost/refunding - - Expensive/cannot afford it - - No time - Self checks show no symptoms - Lack of information - Neglectfulness/procrastination Important in a particular group of women - Exam by a doctor (other than mammogram) - Overcodes Basis: Subsample (never have had a breast cancer screening before) Total: n = Qb: Would you please tell us why you have never had a breast cancer screening exam before?

19 .. a. Breast cancer examination - Frequency About half of the women go the breast cancer screening examination once a year. In Sweden every other year is the most common frequency to go to breast cancer screening examination, whereas in Russia half of the women indicate going irregularly. total USA Germany Brazil China Russia India Sweden Austria Once a year Every years Irregularly Don't know Basis: Subsample (Have had a breast screening examination before): n = Qc: How often do you go to breast cancer screening examinations?

20 a. Breast cancer screening - Importance USA: Education.. total Low Mid High Once a year Every years Irregularly Don't know Basis: Subsample (Have had a breast screening examination before): n = Qc: How often do you go to breast cancer screening examinations?

21 a. Breast cancer screening - Importance Brazil: Age.. total - years - years - years - years Once a year Every years Irregularly Don't know Basis: Subsample (Have had a breast screening examination before): n = Qc: How often do you go to breast cancer screening examinations?

22 a. Breast cancer screening - Importance Brazil: Education.. total Low Mid High Once a year Every years Irregularly Don't know Basis: Subsample (Have had a breast screening examination before): n = Qc: How often do you go to breast cancer screening examinations?

23 a. Breast cancer screening - Importance Russia: Age.. total - years - years - years - years Once a year Every years Irregularly Don't know Basis: Subsample (Have had a breast screening examination before): n = Qc: How often do you go to breast cancer screening examinations?

24 a. Breast cancer screening - Importance Sweden: Age.. total - years - years - years - years Once a year Every years Irregularly Don't know Basis: Subsample (Have had a breast screening examination before): n = Qc: How often do you go to breast cancer screening examinations?

25 a. Breast cancer screening Personal experiences Breast cancer screenings are mainly perceived as a positive or neutral experiences. In Brazil and China even more than three quarters of the women indicate that the experience was positive... total USA Germany Brazil China Russia India Sweden Austria Positively Negatively Neutral Don't know Basis: Subsample (Have had a breast screening examination before): n = Q: What were your personal experiences at your last breast cancer screening? How did you perceive the breast cancer screening exam?

26 .. a. Breast cancer screening - Description of perception (I) Positively Open answers Answers % Total USA Germany Brazil China Russia India Sweden Austria Positive/neutral (in general) Because it has to be done - Was a positive experience - - Helps to detect cancer It is helpful Quick results/clarity Results showed no cancer - - Clarity - Quick and easy test procedure - Quick and easy test to do - - Did not hurt at all - Overcodes Basis: Subsample (positive experience Q and have had a breast cancer examination): n = Q: Please briefly explain your perception. Why did you perceive the screening exam positively / negatively?

27 .. a. Breast cancer screening - Description of perception (II) Positively Open answers Answers % Total USA Germany Brazil China Russia India Sweden Austria Peace of mind/relief I felt good because afterwards - Professional - - medical staff were well trained - - Caring and responsive staff - Staff were friendly - - Informative staff/good explanation - Staff were informative - Done by a person whom I trust - Overcodes Basis: Subsample (positive experience Q and have had a breast cancer examination): n = Q: Please briefly explain your perception. Why did you perceive the screening exam positively / negatively?

28 .. a. Breast cancer screening examination Components Globally the mammogram together with the clinical breast examination and the discussion with the doctor are most often perceived as components of a breast cancer screening examination. Clinical breast exam Mammogram Ultrasound Discussion with the doctor Total USA Germany Brazil China Russia India Sweden Austria Other Do not know Multiple answers Basis: Total: n = Qa: In your opinion, what does a breast cancer screening examination include?

29 .. a. Breast cancer screening - Associations The majority of the women associate the feeling to have done everything possible to prevent breast cancer with "breast cancer screening". In Russia and especially in India the fear of the examination results also play an important role when thinking about "breast cancer screening". Peace of mind, having done what is currently possible to prevent or identify early a dangerous disease Fear of the examination results Do not know Other Total USA Germany Brazil China Russia India Sweden Austria Multiple answers Basis: Total: n = Qb: When you hear the term breast cancer screening, what do you personally associate with the term?

30 a. Breast cancer screening - Concerns Globally one third of the women indicate that they do not have any concerns which prevent them from seeking breast cancer screening. However, in India many concerns are considered to limit the willingness to go to a breast cancer screening... Doubts whether screening is effective Fear of complications Fear of the examination results Long waiting periods before the screening exam Costs are too high Fear of pain during the examination Fear of radiation Not in the defined agegroup (younger or older than target group) Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = Qc Do you consider any of the following to be concerns that might limit you or prevent you from seeking breast cancer screening? Religious and/or cultural reasons No access, or limited access, to healthcare None of above Other Multiple answers

31 a. Breast cancer screening - Importance Statement: Costs are too high USA: Age/Education.. Age Education - years total - years Low Education - years Mid Education - years High Education Costs are too high Basis: Total: n = (USA) Qc Do you consider any of the following to be concerns that might limit you or prevent you from seeking breast cancer screening?

32 a. Breast cancer screening - Importance Statement: Fear of radiation China: Age/Education.. Age Education - years total - years Low Education - years Mid Education - years High Education Fear of radiation Basis: Total: n = (China) Qc Do you consider any of the following to be concerns that might limit you or prevent you from seeking breast cancer screening?

33 .. a. Breast cancer screening Familiar diagnostic methods Mammography is the best known diagnostic method used in breast cancer screening. Ultrasound follows on rank two. Ultrasound Mammography / Mammogram Magnetic Resonance Imaging (MRI) PET-CT Computed Tomography (CT) Other None of the above Total USA Germany Brazil China Russia India Sweden Austria Multiple answer Basis: Total: n = Q: Which of the following diagnostic methods used in breast cancer screening are you familiar with?

34 .. a. Breast cancer screening - Motivation More than half of the women would be motivated to have a breast cancer screening either if they were educated on self-exam or if they belonged to a risk group. Self exam / Education on self-exam (USA) Belonging to a risk group Cancer in the past Knowing someone with breast cancer Discussion with friends and / or family Referral to a specialist Newspaper article Discussion with the doctor / Recommendation by my physician (USA) Total USA Germany Brazil China Russia India Sweden Austria Other Do not know Multiple answers Basis: Total: n = Q.What would motivate you to have a breast cancer screening examination?

35 a. Breast cancer screening - Official screening program Almost half of the women are not aware of whether there is an official screening program in their country. Exception: In India three quarters of the women state that there is an official screening program... total USA Question in USA: Is there an official screening program you are eligible to participate in? Germany Brazil China Russia India Sweden Austria Yes No Do not know Basis: Total: n = Q. Is there an official screening program in your country?

36 a. Breast cancer screening - Official screening program USA: Age/ Education.. Age Education - years total - years Low Education - years Mid Education - years High Education Yes No Do not know Question in USA: Is there an official screening program you are eligible to participate in? Basis: Total: n = (USA) Q. Is there an official screening program in your country?

37 a. Breast cancer screening - Official screening program China: Age/ Education.. Age Education - years total - years Low Education - years Mid Education - years High Education Yes No Do not know Basis: Total: n = (China) Q. Is there an official screening program in your country?

38 a. Breast cancer screening - Official screening program Russia: Age/ Education.. Age Education - years total - years Low Education - years Mid Education - years High Education Yes No Do not know Basis: Total: n = (Russia) Q. Is there an official screening program in your country?

39 a. Breast cancer screening - Official screening program Sweden: Age/ Education.. Age Education - years total - years Low Education - years Mid Education - years High Education Yes No Do not know Basis: Total: n = (Sweden) Q. Is there an official screening program in your country?

40 b Information sources

41 .. b. Information sources - Most trustworthy source Overall it is the gynecologist who is perceived as the most trustworthy information source, followed by the family physician. total Single Choice USA Germany Brazil China Russia India Sweden Austria Mother Other family member, e.g. sister Best friend Family physician Gynecologist Governmental information center Independent information center Governmental agency (e.g. Department of Health) Do not know Other Basis: Total: n = Q. Which person do you trust the most concerning the issue breast cancer screening?

42 .. b. Information sources - Information channels Globally the women are most likely to think that it is possible to receive information about breast cancer screening from the gynecologists followed by the family physician. Gynecologist Family physician Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies (e.g. Department of Health) Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = Qa. From which of the following information channels do you think general information about breast cancer screening is available, independent of whether you have used these channels or not? Other None Multiple answers

43 .. b. Information sources - Trustworthiness The gynecologist is by far the most trustworthy information source, followed by the family physician. The other information sources play a minor role. Total Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

44 .. b. Information sources Trustworthiness In the USA the gynecologist and family physician are perceived almost equally trustworthy. USA Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

45 .. b. Information sources - Trustworthiness In Germany the gynecologist is by far the most trustworthy information source, followed by the family physician. Germany Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

46 .. b. Information sources - Trustworthiness The gynecologist is the most trustworthy information source. Besides the gynecologist, health reports on television and specialty magazines are also perceived as quite trustworthy. Brazil Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

47 .. b. Information sources - Trustworthiness In China two thirds of the women indicate that the gynecologist is a very trustworthy information source. The family physician plays a minor role. China Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

48 .. b. Information sources - Trustworthiness Compared to the other countries, the Russian women tend to evaluate the trustworthiness of the gynecologist as quite low although the gynecologist is still the most trustworthy information source. Russia Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

49 b. Information sources - Trustworthiness The gynecologist and the family physician are perceived as the most trustworthy information sources... India Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

50 .. b. Information sources - Trustworthiness The gynecologist together with the family physician are perceived as the most trustworthy information sources. Interestingly governmental agencies are also evaluated quite trustworthy. Sweden Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

51 .. b. Information sources - Trustworthiness The gynecologist is the most trustworthy information source. Almost all Austrian women state that the gynecologist is very trustworthy. Austria Gynecologist Family physician Scale: = not trustworthy = very trustworthy Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient self-help organizations Official public information centers Independent information centers Governmental agencies Top Box (+) Middle Box (+) Bottom Box (+) N.A. Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

52 .. b. Information sources - Trustworthiness (Country comparison) The gynecologist is the most trustworthy information source in all countries, whereas in Germany and in Austria he is evaluated as very trustworthy. Gynecologist Top--Boxes (+) Family physician Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Total USA Germany Brazil China Russia India Sweden Austria Patient self-help organizations Official public information centers Independent information centers Governmental agencies Basis: Total: n = Qb. And, which of the following information channels or sources of information do you consider especially trustworthy regarding breast cancer screening?

53 .. b. Information received from the following sources Globally the gynecologist is by far the most often used information source followed by the family physician, family or friends, women's magazines and health reports on television. Gynecologist Family physician Pharmacist Family or friends Women s magazines Specialty magazines Weekly magazines Newspapers Health reports on television Internet Patient online communities Patient selfhelp organizations Official public information centers Independent information centers Governmental agencies (e.g. Department of Health) Total USA Germany Brazil China Russia India Sweden Austria Other None Multiple answers If more than one answers were given, the woman got the question Q. The results of Q are mostly the same as Q. Basis: Total: n = Q. And, from which of these information sources have you personally received information about breast cancer screening?

54 .. b. Evaluation of information provided by the doctor Overall, slightly more than two thirds of the women indicate that they feel well informed about breast cancer. In Sweden the share is considerably smaller only one quarter of the women feel well informed. total USA Germany Brazil China Russia India Sweden Austria Yes No Do not know Basis: Total: n = Q. What do you think about the breast cancer information your doctor communicates to you? Do you feel, that your doctor, especially your gynecologist informs you well?

55 .. b. Information sources - Familiar services Overall, the women are most familiar with consultations with the physician either preliminary to or after the examination and with informational material. Interestingly almost half of the Swedish women indicate that they do not know any of the mentioned services. Report of results from the radiologist Other None of above Total USA Germany Brazil China Russia India Sweden Austria Informational material (e. g. pamphlet or online information) Preliminary consultation with the physician Explanation by the physician s practice personnel (eg, a nurse or radiology technologist) Consultation with the physician following the examination Basis: Total: n = Qa: Which of the following services, before or after breast cancer screening, are you familiar with? Multiple answers

56 .. b. Information sources - Most important service More than two thirds of the women state that the consultation either preliminary to or after the examination is the most important service. Report of results from the radiologist Other Total USA Germany Brazil China Russia India Sweden Austria Informational material (e. g. pamphlet or online information) Preliminary consultation with the physician Explanation by the physician s practice personnel (eg, a nurse or radiology technologist) Consultation with the physician following the examination Single choice Basis: Subsample (more than one answer in Qa): n = Qb: And, which of the services that you selected is the single most important one to you?

57 .. b. Information sources - Required information or information offers The women are mainly interested in information related to the procedure and further information about the disease. In Germany and Austria one fifths of the women indicate that the current information is enough. Open answers Answers % Total USA Germany Brazil China Russia India Sweden Austria Doctors advice Booklets and pamphlets/brochures - Information related to the procedure exact description of the procedure Disease information Cancer preventive measure Right time to undergo screening - Current information is enough Information related to the results Don't know Overcodes Basis: Total: n = Q. When you think of breast cancer screening overall, which information or information offers would you like to have?

58 c Statement analysis

59 .. c. Statement analysis The public awareness of breast cancer and breast cancer screening is important to more than three quarters of the woman. Furthermore three out of four women require information material that contains understandable medical explanations. Total wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

60 .. c. Statement analysis In the USA the public awareness of breast cancer and breast cancer screening is important to almost three quarters of the woman. Additionally more than two thirds of the women want to receive information material that contains understandable medical explanations. USA wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

61 .. c. Statement analysis In Germany it is also the public awareness of breast cancer / screening which concerns the women the most. About two thirds of the women agree on the fact that breast cancer is a widespread disease. Germany wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

62 .. c. Statement analysis The majority of the women in Brazil agree that the public awareness of breast cancer/ screening is important. Interestingly only about one quarter of the women fully agree on the fact that breast cancer is a widespread disease. Brazil wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

63 .. c. Statement analysis Besides the importance of the public awareness more than three quarters of the Chinese women are willing to actively support the topic. China wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

64 .. c. Statement analysis In Russia it is also the public awareness of breast cancer / screening which most women think is important. Russia wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

65 .. c. Statement analysis In India there is not much differentiation between the messages. More than three out of four women agree on every statement. India wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

66 c. Statement analysis In Sweden it is also the public awareness of breast cancer / screening which concerns the women the most. Furthermore almost three quarters of the women agree on the fact that breast cancer is a widespread disease... Sweden wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

67 .. c. Statement analysis More than three quarters of the Austrian women agree on the fact that the public awareness of breast cancer / screening is important. Besides that almost three quarters want to receive understandable medical explanations. Austria wide-spread disease gather information consciously and independently important that public is informed about breast cancer Scale: = do not agree at all = fully agree have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Top Box (+) Middle Box (+) Bottom Box (+) Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

68 .. c. Statement analysis Country comparison All countries agree on the fact that it is vital that the public is informed about breast cancer and screening. Furthermore they agree on the importance of understandable medical information material and information about examination procedures. wide-spread disease Top--Boxes (+) gather information consciously and independently important that public is informed about breast cancer have been asked for the advice on the topic of breast cancer and breast cancer screening willing to actively support the topic actively inform family and friends about breast cancer screening important to receive information material containing understandable medical explanations important to receive information material containing information about examination procedures to receive information material containing clinical images Total USA Germany Brazil China Russia India Sweden Austria to receive information material containing technical illustrations to receive information material containing real stories and statements to receive information material containing real pictures or reviews of affected people interested in information containing costs, life expectancy and the general impact on society and the hc system Basis: Total: n = Q: Now you will see a list of statements. Please tell us which of these statements you agree with and which you do not.

69 Realization of sample

70 .. Age Overall, on average the women are approximately years of age.,, - years - years - years - years Total USA Germany Brazil China Russia India Sweden Austria Mean:,,,,,,,, Basis: Total: n = B: Age

71 .. Highest educational qualification Half of the respondents have a middle educational qualification. Low education Mid education High education Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = C: Highest educational qualification

72 .. Profession More than two thirds of the women are white collar employees. In India the majority of the women are housewives. blue-collar worker white-collar employee government employee Basis: Total: n = D: Profession self-employed farmer retired Total USA Germany Brazil China Russia India Sweden Austria housewife presently unemployed student/pupil

73 .. Size of household Half of the women live in a two or three person household., Total USA Germany Brazil China Russia India Sweden Austria >, Basis: Total: n = E: Size of household

74 .. Number of children under living in the household More than half of the women state that they have no children under years living in their household. children child children or more children Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = F: How many children under years live in your household?

75 .. Total monthly income Overall the sample is equally spread over the income categories..... bis and more Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = G: Total monthly net income of your household

76 .. Size of town Almost half of the women indicate that they live in a town with more than, inhabitants. <, inhabitants, -, inhabitants, -, inhabitants, and more inhabitants,,,, -, inhabitants Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = J: Size of town

77 Religion.. Hinduism Christianity,, Buddhism Islam, Judaism Open answers,, Total USA Germany Brazil China Russia India Sweden Austria Basis: Total: n = J: What is your religion?

78 Management summary

79 .. Management Summary Breast cancer screening Importance Breast cancer screening is an important topic for the majority of women. Especially in Brazil almost all women indicate that breast cancer screening is very important. However, in the US only about two thirds of the women evaluate the importance of breast cancer screening as very high. Knowledge The knowledge about breast cancer differs considerably among the countries. Overall about % of the women rate their knowledge as good or very good. The Indian women feel the best informed three out of four women state that their knowledge is good or very good, whereas in China, Russia and Sweden under one third of the women indicate to be well or very well informed about breast cancer screening. Usage Overall approximately two out of three women have had a breast cancer screening so far. In Austria and Germany the share is even higher more than three quarters of the women state that they have had a screening. While in China, Russia, India and Sweden slightly more than half of the women have had a screening.

80 .. Management Summary Breast cancer screening Frequency Overall, it is most common to go to the breast cancer screening once a year. However, in Sweden most women indicate that they go every other year to the examination, and in Russia the majority of the women state that they go to the screening irregularly. Personal experience Breast cancer screenings are usually perceived as a positive or at least neutral experience. In Brazil and China the vast majority of the women indicate that their experience was positive. In Germany and Austria the women tend to describe their experience as rather neutral. The number of women who have had a negative experience is quite small among all countries. Components of the screening/examination According to the majority of the women a breast cancer screening examination includes a mammogram, a clinical breast examination and the discussion with the physician. Associations When thinking about breast cancer screening the majority of the female population associates the feeling to have done everything possible to prevent breast cancer. In Russia and especially in India the fear of the results also plays an important role.

81 .. Management Summary Breast cancer screening Concerns Overall one third of the women state that they do not have any concerns which prevent them from seeking breast cancer screening. Especially in Sweden the share of women who have no concerns is quite high at %, whereas particularly in India many concerns are considered to limit the willingness to go to a breast cancer screening (e.g. doubts about the effectiveness, fear of complications, fear of the results) and also in China many women are concerned about the high costs and possible radiation. Familiar diagnostic methods Besides mammography/mammogram, which is by far the best known diagnostic method, ultrasound is also known to many women. Slightly less than one third of the women also state that they are familiar with MRI, especially in India this method is known to half of the respondents. Motivation The women are mostly motivated to have a breast cancer screening by having education on self-examination or because they belong to a risk group. Official screening program Overall almost half of the women are not aware of whether there is an official screening program in their country. Especially in Russia and in Austria the awareness is quite low at %. The exception is India: three quarters of the women state that there is an official screening program.

82 .. Management Summary Information sources Most trustworthy source Overall it is the gynecologist who is perceived as the most reliable person. The family physicians follow at rank two. Particularly in Germany and in Austria the gynecologist plays by far the most important role. In the US the family physician is as important as the gynecologist and in India he is perceived as even more reliable than the gynecologist. Interestingly in Sweden the gynecologist, the family physician, the governmental information center and the governmental agency are perceived as equally trustworthy and almost one third indicated not to know which person is the most trustworthy. Availability of information Overall the women think they would most likely receive information from the gynecologist. Other possible information sources are the family physician, followed by health reports on TV, women's magazines and specialty magazines. In Sweden governmental agencies also play an important role. Reliability In all countries the gynecologist is rated as the most reliable information source especially in Germany and Austria more than % of the women state that the gynecologist is very trustworthy.

83 .. Management Summary Information sources Familiar services Overall consultations with the physician either preliminary to or after the examination and informational material (e.g. pamphlet or online information) are the services the women are the most familiar with. Interestingly in Sweden the consultations with the physicians are much less familiar to the women than in the other countries and almost half of the women indicate not knowing any of the services. Most important service The most important services are the consultations with the physician either preliminary to or after the examination. Information provided by the physician Overall approximately two thirds of the women feel well informed by their physician. This is particularly so in Austria and India where more than three quarters of the women indicate being well informed. In Russia and especially in Sweden the share is considerably smaller about half of the women in Russia and only one quarter in Sweden feels well informed about breast cancer.

84 .. Management Summary Messages Analysis Overall it is the importance of the public awareness of breast cancer and breast cancer screening on which the women agree the most. Furthermore, women of all countries agree on the importance of information material that contains understandable medical explanations and information about examination procedures. Interestingly in India there is not much differentiation between the messages. More than three quarters of the women agree on every statement.