Fear Despite Knowledge: Cancer Knowledge, Awareness, and Attitudes Among Health Sciences Students

Abstract

Cancer remains a major public health concern not only in terms of its medical burden but also because of the perceptions, fears, and attitudes it creates in society. This study aimed to evaluate cancer-related knowledge, awareness, attitudes, and behavioral tendencies among Faculty of Health Sciences students. Data were collected online and face-to-face from 336 volunteer students (245 females, 91 males) aged ≥ 18 who were able to read and understand Turkish. Participants completed the Cancer-Related Knowledge, Awareness, and Attitudes Form designed to assess cancer knowledge and attitudes. The mean cancer knowledge score of the students was 13.11±2.62. Although the overall knowledge level was relatively high, 74% of the participants reported fear of cancer. No significant association was found between fear of cancer and smoking or alcohol use, regular exercise, family history of cancer, or bereavement due to cancer (p>0.05). Furthermore, multivariable binary logistic regression analysis revealed that after adjusting for all potential confounders, gender was the sole independent predictor of cancer fear, with female students being 2.16 times more likely to experience this fear than males (adjusted OR = 2.16, 95% CI: 1.25–3.72, p = 0.006). Conversely, students who reported a fear of developing cancer demonstrated significantly higher knowledge scores than those without this fear (p<0.001). The findings indicate that higher knowledge does not eliminate cancer-related fear, suggesting that emotional responses must be addressed alongside informational components. Integrating psychosocial dimensions and interdisciplinary approaches into educational programs will strengthen both knowledge and attitudes, contributing to more comprehensive preventive health strategies.

Keywords

• Awareness
• Cancer
• Health Knowledge
• Attitude
• Practice
• Students
• Health Attitude.

Ethical Statement

The data for this research article were obtained in accordance with the ethics committee approval granted by the Non-Interventional Clinical Research Ethics Committee of Fenerbahçe University, at its decision dated “12.03.2024” and numbered “38.2024fbu”.

Bilgiye Rağmen Korku: Sağlık Bilimleri Öğrencilerinde Kanser Bilgisi, Farkındalık ve Tutumlar

Abstract

Kanser, yalnızca tıbbi yükü açısından değil, aynı zamanda toplumda oluşturduğu algılar, korkular ve tutumlar nedeniyle de önemli bir halk sağlığı sorunu olmaya devam etmektedir. Bu çalışma, Sağlık Bilimleri Fakültesi öğrencilerinin kansere ilişkin bilgi düzeylerini, farkındalıklarını, tutumlarını ve davranış eğilimlerini değerlendirmeyi amaçlamıştır. Veriler, Türkçe okuyup anlayabilen ve 18 yaş ve üzerinde olan 336 gönüllü öğrenciden (245 kadın, 91 erkek) çevrim içi ve yüz yüze yöntemlerle toplanmıştır. Katılımcılar, kanser bilgi düzeyi ve tutumlarını değerlendirmek amacıyla hazırlanan Kanserle İlgili Bilgi, Farkındalık ve Tutum Formu’nu doldurmuştur. Öğrencilerin ortalama kanser bilgi puanı 13,11±2,62 olarak bulunmuştur. Genel bilgi düzeyi görece yüksek olmasına rağmen, katılımcıların %74’ü kanser korkusu yaşadığını bildirmiştir. Kanser korkusu ile sigara veya alkol kullanımı, düzenli egzersiz yapma, ailede kanser öyküsü bulunması ya da kanser nedeniyle yakın kaybı yaşama arasında anlamlı bir ilişki saptanmamıştır (p>0,05). Ayrıca, çok değişkenli ikili lojistik regresyon analizi sonucunda, tüm olası karıştırıcı değişkenler için düzeltme yapıldıktan sonra, cinsiyetin kanser korkusunun tek bağımsız belirleyicisi olduğu gösterilmiş; kadın öğrencilerin erkek öğrencilere kıyasla kanser korkusu yaşama olasılığının 2,16 kat daha yüksek olduğu belirlenmiştir (düzeltilmiş OR=2,16; %95 GA: 1,25–3,72; p=0,006). Buna karşılık, kansere yakalanma korkusu olduğunu bildiren öğrencilerin bilgi puanlarının, bu korkuyu taşımayan öğrencilere göre anlamlı düzeyde daha yüksek olduğu bulunmuştur (p<0,001). Bulgular, bilgi düzeyinin yüksek olmasının kanserle ilişkili korkuyu ortadan kaldırmadığını ve bilgilendirici bileşenlerin yanı sıra duygusal tepkilerin de ele alınması gerektiğini göstermektedir. Eğitim programlarına psikososyal boyutların ve disiplinlerarası yaklaşımların entegre edilmesi, hem bilgi düzeyini hem de tutumları güçlendirerek daha kapsamlı koruyucu sağlık stratejilerinin geliştirilmesine katkı sağlayacaktır.

Keywords

• Farkındalık
• Kanser
• Öğrenciler
• Sağlık Bilgisi
• Tutum
• Davranış
• Sağlık Tutumu.

Ethical Statement

Bu araştırma makalesinin verileri, Fenerbahçe Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’nun “12.03.2024” tarih ve “38.2024fbu” protokol numaralı kararıyla alınan etik kurul izni doğrultusunda elde edilmiştir.

References

1. Akkanat Karagil, F. M., & Harmancı, H. (2022). Kanser tanısı alan birey ve ailesinde ruh sağlığı. Karatay Sosyal Araştırmalar Dergisi, (9), 63-90. https://doi.org/10.54557/karataysad.1172368
2. Al-taie, A., & Bakur, A. (2024). Assessment of knowledge of cancer risk factors and awareness of early cancer warning signs among university students. Clinical and Experimental Health Sciences, 14(1), 139-145. https://doi.org/10.33808/clinexphealthsci.1235753
3. Anampa-Guzmán, A., Brito-Hijar, A. D., Gutierrez-Narvaez, C. A., Molina-Ruiz, A. R., Simo-Mendoza, V., González-Woge, M., de la O Murillo, A., & Leon-Ferre, R. (2020). American Society of Clinical Oncology–sponsored oncology student interest groups in Latin America. JCO Global Oncology, (6), 1439-1445. https://doi.org/10.1200/GO.20.00363
4. Anampa-Guzmán, A., Loli-Guevara, S., Gutierrez-Narvaez, C. A., Nimboma, L. E., & Leon-Ferre, R. (2021). ASCO-sponsored oncology student interest groups in the world. JCO Global Oncology, (7), 1586-1592. https://doi.org/10.1200/GO.21.00353
5. Andrade, C., Menon, V., Ameen, S., & Kumar Praharaj, S. (2020). Designing and conducting knowledge, attitude, and practice surveys in psychiatry: Practical guidance. Indian Journal of Psychological Medicine, 42(5), 478-481. https://doi.org/10.1177/0253717620946111
6. Azadi, N. A., Ziapour, A., Mohammadkhah, F., Darabi, F., Yoosefi Lebni, J., Chaboksavar, F., Yıldırım, M., & Kianipour, N. (2025). Effects of an educational health belief model program on promoting preventive behaviors for breast cancer among women in Iran. Journal of Patient Experience, 12. https://doi.org/10.1177/23743735251341719
7. Bayrak, U., Gram, E., Mengeş, E., Okumuş, Z., Sayar, H., & Skrijelj, E. (2010). Üniversite öğrencilerinin sağlıkla ilgili alışkanlıklar ve kanser konusundaki bilgi ve tutumları. Dokuz Eylül Üniversitesi Tıp Dergisi, 24(3), 95-104.
8. Bettinghaus, E. P. (1986). Health promotion and the knowledge-attitude-behavior continuum. Preventive Medicine, 15(5), 475-491. https://doi.org/10.1016/0091-7435(86)90025-3

9. Cal, A., Kabatas Yildiz, M., & Aydin Avci, I. (2018). Examination of knowledge and fear levels of breast cancer with the spiritual characteristics of nurses. Frontiers in Public Health, 6. https://doi.org/10.3389/fpubh.2018.00331
10. Cao, W., Chen, H.-D., Yu, Y.-W., Li, N., & Chen, W.-Q. (2021). Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chinese Medical Journal, 134(7), 783-791. https://doi.org/10.1097/CM9.0000000000001474
11. Denniss, E., Lindberg, R., & McNaughton, S. A. (2022). Development of principles for health-related information on social media: Delphi study. Journal of Medical Internet Research, 24(9), e37337. https://doi.org/10.2196/37337
12. Domingo-Osle, M., La Rosa-Salas, V., Ambrosio, L., Elizondo-Rodriguez, N., & Garcia-Vivar, C. (2021). Educational methods used in cancer training for health sciences students: An integrative review. Nurse Education Today, 97, 104704. https://doi.org/10.1016/j.nedt.2020.104704
13. Erdem, S., Yılmaz, M., Yıldırım, H., Mayda, A., Bolu, F., Durak, A., & Şener, Ö. (2017). Düzce’de yaşayanların kanser ve kanser risk faktörleri hakkında bilgi düzeyi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 7(1), 1-10.
14. Escoto-Vasquez, L.-S., Alarcón-Sánchez, M. A., Rodríguez-Montaño, R., Becerra-Ruiz, J. S., Lomelí-Martínez, S. M., & Heboyan, A. (2025). Knowledge and awareness of medical and dental students about oral cancer risk factors: A systematic review and meta-analysis. Cancer Control, 32. https://doi.org/10.1177/10732748251316603
15. Estaville, L., Trad, M., & Martinez, G. (2012). University student understanding of cancer: Analysis of ethnic group variances. Journal of Cancer Education, 27(3), 580-584. https://doi.org/10.1007/s13187-012-0356-x
16. Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. https://doi.org/10.3758/BF03193146
17. Friedenreich, C. M., Ryder‐Burbidge, C., & McNeil, J. (2021). Physical activity, obesity and sedentary behavior in cancer etiology: Epidemiologic evidence and biologic mechanisms. Molecular Oncology, 15(3), 790-800. https://doi.org/10.1002/1878-0261.12772
18. Gautreau, C. M., Sherry, S. B., Sherry, D. L., Birnie, K. A., Mackinnon, S. P., & Stewart, S. H. (2015). Does catastrophizing of bodily sensations maintain health-related anxiety? A 14-day daily diary study with longitudinal follow-up. Behavioural and Cognitive Psychotherapy, 43(4), 502-512. https://doi.org/10.1017/S1352465814000150
19. Güçler, A. (2022). The shift from international to global health policy: Actors, frameworks, and challenges. İmgelem, 6(10), 277-294. https://doi.org/10.53791/imgelem.995751
20. Hadjistavropoulos, H. D., Craig, K. D., & Hadjistavropoulos, T. (1998). Cognitive and behavioral responses to illness information: The role of health anxiety. Behaviour Research and Therapy, 36(2), 149-164. https://doi.org/10.1016/S0005-7967(98)00014-X
21. Hanahan, D. (2022). Hallmarks of cancer: New dimensions. Cancer Discovery, 12(1), 31-46. https://doi.org/10.1158/2159-8290.CD-21-1059
22. Johannes, C., Roman, N. V., Onagbiye, S. O., Titus, S., & Leach, L. L. (2024). Strategies and best practices that enhance the physical activity levels of undergraduate university students: A systematic review. International Journal of Environmental Research and Public Health, 21(2), 173. https://doi.org/10.3390/ijerph21020173
23. Johnson, S. B., Parsons, M., Dorff, T., Moran, M. S., Ward, J. H., Cohen, S. A., Akerley, W., Bauman, J., Hubbard, J., Spratt, D. E., Bylund, C. L., Swire-Thompson, B., Onega, T., Scherer, L. D., Tward, J., & Fagerlin, A. (2022). Cancer misinformation and harmful information on Facebook and other social media: A brief report. JNCI: Journal of the National Cancer Institute, 114(7), 1036-1039. https://doi.org/10.1093/jnci/djab141
24. Kassie, A. M., Abate, B. B., Kassaw, M. W., & Shiferaw, W. S. (2021). Breast self-examination practice among female university students in Ethiopia: A systematic review and meta-analysis. Cancer Control, 28. https://doi.org/10.1177/10732748211019137
25. Leventhal, H., Phillips, L. A., & Burns, E. (2016). The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. Journal of Behavioral Medicine, 39(6), 935-946. https://doi.org/10.1007/s10865-016-9782-2
26. Lin, L., Zhang, X., Yu, M., Bernardo, B., Adeyanju, T., & Paskett, E. D. (2023). The relationship between family history of cancer and cancer attitudes; beliefs within the Community Initiative Towards Improving Equity and Health Status (CITIES) cohort. PLOS ONE, 18(6), e0287629. https://doi.org/10.1371/journal.pone.0287629
27. Marino, P., Mininni, M., Deiana, G., Marino, G., Divella, R., Bochicchio, I., Giuliano, A., Lapadula, S., Lettini, A. R., & Sanseverino, F. (2024). Healthy lifestyle and cancer risk: Modifiable risk factors to prevent cancer. Nutrients, 16(6), 800. https://doi.org/10.3390/nu16060800
28. Núñez-Peña, E., Siller-Garcia, P., Vaca-Cartagena, B. F., Lucio-Lozada, J., Villafuerte-Manrique, S., Barrera López, M., Mesa-Chavez, F., & Villarreal-Garza, C. (2022). Activities performed by ASCO-sponsored oncology student interest groups in Latin America: Assessing members’ preferences and leaders’ challenges. JCO Global Oncology, (8). https://doi.org/10.1200/GO.22.00050
29. Ozmen, O., & Alper, C. M. (2017). Cancer early diagnosis, screening, and education centers in Turkey. Cancer Surgery, 02(02). https://doi.org/10.4172/2573-542X.1000e101
30. Peduzzi, P., Concato, J., Kemper, E., Holford, T. R., & Feinstein, A. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49(12), 1373-1379. https://doi.org/10.1016/S0895-4356(96)00236-3
31. Peng, Y., Zhang, K., Wang, L., Peng, Y., Liu, Z., Liu, L., Luo, Y., & Gu, C. (2022). Effect of a telehealth-based exercise intervention on the physical activity of patients with breast cancer: A systematic review and meta-analysis. Asia-Pacific Journal of Oncology Nursing, 9(12), 100117. https://doi.org/10.1016/j.apjon.2022.100117
32. Poyraz, N., & Korkmaz, M. (2022). Determination of awareness of university students about cancer risk factors. Cyprus Journal of Medical Sciences, 7(4), 484-494. https://doi.org/10.4274/cjms.2020.1868
33. Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403
34. Roshandel, G., Ghasemi-Kebria, F., & Malekzadeh, R. (2024). Colorectal cancer: Epidemiology, risk factors, and prevention. Cancers, 16(8), 1530. https://doi.org/10.3390/cancers16081530
35. Roy, P., & Saikia, B. (2016). Cancer and cure: A critical analysis. Indian Journal of Cancer, 53(3), 441-442. https://doi.org/10.4103/0019-509X.200658
36. Rucinska, M., Sroda, R., Wilk, O., Saied, A., Miloszewski, J., Sugajska, A., & Osowiecka, K. (2021). Polish high school students’ knowledge about cancer. International Journal of Environmental Research and Public Health, 18(9), 4765. https://doi.org/10.3390/ijerph18094765
37. Sharifikia, I., Rohani, C., Estebsari, F., Matbouei, M., Salmani, F., & Hossein-Nejad, A. (2019). Health belief model-based intervention on women’s knowledge and perceived beliefs about warning signs of cancer. Asia-Pacific Journal of Oncology Nursing, 6(4), 431-439. https://doi.org/10.4103/apjon.apjon_32_19
38. Suarez-Lledo, V., & Alvarez-Galvez, J. (2021). Prevalence of health misinformation on social media: Systematic review. Journal of Medical Internet Research, 23(1), e17187. https://doi.org/10.2196/17187
39. Tomic, M., Vescan, M.-L., & Ungureanu, M.-I. (2023). Exploring female medical students’ knowledge, attitudes, practices, and perceptions related to breast cancer screening: A scoping review. Journal of Medicine and Life, 16(12), 1732-1739. https://doi.org/10.25122/jml-2023-0412
40. World Health Organization. (2022). Cancer (Fact sheet). https://www.who.int/news-room/fact-sheets/detail/cancer
41. Xiong, X., Zheng, L.-W., Ding, Y., Chen, Y.-F., Cai, Y.-W., Wang, L.-P., Huang, L., Liu, C.-C., Shao, Z.-M., & Yu, K.-D. (2025). Breast cancer: Pathogenesis and treatments. Signal Transduction and Targeted Therapy, 10(1), 49. https://doi.org/10.1038/s41392-024-02108-4
42. Yıldız Çilengiroğlu, İ., Ünsar, S., & Erol, Ö. (2022). Üniversite öğrencilerinin kanser farkındalık düzeylerinin belirlenmesi. Avrasya Sağlık Bilimleri Dergisi, 5(3), 19-27. https://doi.org/10.53493/avrasyasbd.1032065
43. Zucker, H. A. (2020). Tackling online misinformation: A critical component of effective public health response in the 21st century. American Journal of Public Health, 110(S3), S269-S269. https://doi.org/10.2105/AJPH.2020.305942