Introduction

Perceptions of risk for disease are important because they have been found to influence health behaviors. If people believe themselves to be at risk for a condition, they are more likely to do something about it. For instance, women who perceive themselves to be vulnerable to breast cancer or are worried about it are more likely to seek regular mammograms, in comparison to women who worry less or see themselves as less vulnerable¹.

In order to better understand women's perception of risk for major illnesses, researchers surveyed middle-aged and older women to find out how much they knew about major health problems. The results were surprising, in that women in general knew more about men's health problems in comparison to women's health problems.

Researchers at Stanford University surveyed 200 women (ages 41-95) in the San Francisco Bay Area. They were recruited through various settings including health fairs, informational talks, and the work place. Study participants completed surveys between April 1997 and March 1998. Approximately two-thirds of the women completed the questionnaire in person and the rest returned their responses via mail.

Women in this study were asked about their age, ethnicity, marital status, health status, as well as their knowledge about causes of death, beliefs about their risk for diseases, and perceptions of preventability.

Information about leading causes of death

Participants were more accurate in their knowledge of the leading causes of death among men than about the leading causes of death among women. While nearly two-thirds of the women (59%) correctly identified heart disease as the leading cause of death among older men, less than half of the participants (45%) knew that heart disease is also a major health problem for older women.

Overall health knowledge and risk of death

Regardless of their own age, study participants were more accurate in their health knowledge about younger age groups (45 to 64 years) than about older age groups (65 years and above). They also overestimated the risks of death due to breast cancer, while underestimating the risk of death due to lung and colon cancer. Two-thirds of the participants correctly identified breast cancer as the leading cause of cancer death among women between the ages of 45-54. However they mistakenly believed this to be the leading cause of death due to cancer at older ages as well.

Most frequent types of cancer

What women did not know was surprising. Overall, more than 80% of the participants did not know that lung cancer is the leading cause of death due to cancer for women (in the United States) between the ages of 55 to 75. Additionally, the majority of participants did not know that colon cancer is the leading cause of cancer death among women 75 years of age and older.

Perceptions of personal risk for illness

In terms of personal risk, the participants viewed themselves as more likely to develop heart disease than breast, lung or colon cancer. The women also believed they have more control over heart disease than various forms of cancer, both in terms of the course of the disease and its prevention.

Knowledge of disease

Participants held accurate beliefs about the specifics of some diseases. Most knew that a family history of breast cancer increases their risk of developing breast cancer, and that quitting smoking reduces the risk of lung cancer.

The older participants were more likely to think (inaccurately) that a family history of breast cancer does not affect their own levels of risk. They were also likely to wrongly state that men over the age of 65 are more likely to die of heart disease than women over the same age.

Both middle-aged and older women lacked knowledge about the leading causes of death among women, particularly in comparison to what they knew about the leading causes of death among men. They also tended to overestimate the lethality of breast cancer in comparison to other cancers, such as cancer of the lung or colon. Although the risks of breast, lung and colon cancer increase with age, older women believed that they were, in fact, at reduced risk.

The findings of this study are consistent with those of other studies of risk and preventive behaviors. In this study, older women thought they were at reduced risk for breast cancer. Other research has found that as women grow older, their rate of having mammograms decreases². The researchers also cite other studies which document that a large percentage of older Americans are not familiar with ways to screen for colon cancer³. And despite the fact that physical activity is important in reducing the risk of coronary heart disease and colon cancer, women tend to be less active as they age⁴.

Comment

While there are many studies that look at women's perceptions of risk one illness at a time, this one is unique in that it looked at women's perception of risk for multiple illnesses all at once. In addition to telling us about how women assess the comparative risk of one type of cancer with another, it is also telling, in that women seemed to know more about men's health than about their own health.

Healthy aging depends upon good health practices, including attention to lifestyle and disease prevention efforts such as timely cancer screening. But to a great extent, whether or not people engage in health related behavior depends upon their beliefs about being at risk for an illness.

The findings reveal many inaccuracies in women's perceptions of health problems, suggesting the need for improved health education among women. More specifically, there is a need for women to be more aware of the health risks they face. While information about the risk of disease is not, by itself, enough to motivate a person to do something about her health, increased knowledge is certainly an important part of the process.

The women in this study were primarily educated and White, and thus do not represent the entire spectrum of women. Nevertheless, this study clearly points out a need for more accurate health information among women, especially with regard to health risks they may not think of (such as cardiovascular disease and cancer of the colon and lung).