Background There are substantial socioeconomic (SES) differences in both stage of diagnosis of breast cancer and, consequently, survival. These differences are thought to emerge during the patient interval (time between first noticing a symptom and first presentation to a doctor). It has been argued that interventions should seek to ‘equalise awareness of cancer signs and symptoms’ (Rutherford et al, 2013). However, there is little direct evidence about the extent of SES differences in the patient interval, and their underlying reasons. A range of other psychological factors (such as perceived risk, fear and fatalism) may be important, in addition to awareness. This work addresses the ‘Cancer early diagnosis and inequalities’ theme of the EDAG call. Aims To explore socioeconomic differences in the patient interval for breast cancer symptoms and the role of potential mediating factors. Outline plan We will apply our framework to explain SES differences in psychosocial predictors of cancer screening (von Wagner et al, 2011) and use the Symptom and Illness Attitude Model (SIAM; Petersen et al, 2011) to guide research. The primary objectives are to: 1. Review existing literature on factors associated with longer patient intervals for breast cancer to highlight factors relevant to SES and help-seeking. 2. Conduct a vignette study to explore SES differences in responses to breast cancer symptoms. The key outcome is intended time to help-seeking. 3. Examine potential mediators of SES differences in help-seeking, including risk perception, cancer fear and fatalism, by assessing these factors in the vignette survey. 4. Conduct in-depth qualitative work with those reporting breast cancer symptoms to explore symptom interpretation and help-seeking. Outline plan After reviewing the existing literature on factors associated with longer patient intervals and socioeconomic differences in timeliness of presentation for breast cancer, we will conduct two empirical studies; i) a vignette survey using different scenarios of symptomatic presentations to explore patient group differences in intended help-seeking by symptom type (e.g. armpit lump vs. nipple change), and underlying reasons for these differences and ii) a qualitative (semi-structured) interview study of women who have reported at least one potential breast symptom, to further elucidate differences in responses to symptoms by socioeconomic group. How the results will be used The results will lead to further studies of patient factors as a source of socioeconomic and other (age, gender) inequalities, and will be used to inform the development of interventions aimed at reducing inequalities in earlier diagnosis and survival.

Background There are substantial socioeconomic (SES) differences in both stage of diagnosis of breast cancer and, consequently, survival. These differences are thought to emerge during the patient interval (time between first noticing a symptom and first presentation to a doctor). It has been argued that interventions should seek to ‘equalise awareness of cancer signs and symptoms’ (Rutherford et al, 2013). However, there is little direct evidence about the extent of SES differences in the patient interval, and their underlying reasons. A range of other psychological factors (such as perceived risk, fear and fatalism) may be important, in addition to awareness. This work addresses the ‘Cancer early diagnosis and inequalities’ theme of the EDAG call. Aims To explore socioeconomic differences in the patient interval for breast cancer symptoms and the role of potential mediating factors. Outline plan We will apply our framework to explain SES differences in psychosocial predictors of cancer screening (von Wagner et al, 2011) and use the Symptom and Illness Attitude Model (SIAM; Petersen et al, 2011) to guide research. The primary objectives are to: 1. Review existing literature on factors associated with longer patient intervals for breast cancer to highlight factors relevant to SES and help-seeking. 2. Conduct a vignette study to explore SES differences in responses to breast cancer symptoms. The key outcome is intended time to help-seeking. 3. Examine potential mediators of SES differences in help-seeking, including risk perception, cancer fear and fatalism, by assessing these factors in the vignette survey. 4. Conduct in-depth qualitative work with those reporting breast cancer symptoms to explore symptom interpretation and help-seeking. Outline plan After reviewing the existing literature on factors associated with longer patient intervals and socioeconomic differences in timeliness of presentation for breast cancer, we will conduct two empirical studies; i) a vignette survey using different scenarios of symptomatic presentations to explore patient group differences in intended help-seeking by symptom type (e.g. armpit lump vs. nipple change), and underlying reasons for these differences and ii) a qualitative (semi-structured) interview study of women who have reported at least one potential breast symptom, to further elucidate differences in responses to symptoms by socioeconomic group. How the results will be used The results will lead to further studies of patient factors as a source of socioeconomic and other (age, gender) inequalities, and will be used to inform the development of interventions aimed at reducing inequalities in earlier diagnosis and survival.