Beliefs about cancer causation and prevention as a function of personal and family history of cancer: a national, population‐based study

Individuals possess cognitive representations of various diseases and illnesses [1–3]. These illness representations, also known as common sense models of illness, are specific to a particular disease or illness. The representation consists of beliefs about the causes, symptoms, timeline, consequences, and treatment of a given disease or illness. Importantly, the set of beliefs subsumed by the illness representation motivates, guides, and shapes an individual’s health-related behaviors [3–4]. Beliefs about a particular disease can influence whether and how an individual takes steps to reduce the risk for developing that disease or minimizing risk associated with ongoing disease. Consequently, the study of these disease-related beliefs is important for the development of interventions targeting risk-reducing health behaviors. Attribution theory asserts that humans have a need to understand, give meaning to, and ascribe causation to life events [5–6]. This helps explain why individuals are motivated to assign causal beliefs to diseases in illness representations. In addition, attribution theory suggests causal attributions are centrally important in a person’s understanding of the world and, therefore, are important determinants of his/her interactions with that world [5–6]. Most attribution theories assert there is a dimensional structure underlying causal attributions and that categorizing attributions into dimensions allows for increased understanding of causal beliefs. Weiner [7] posits causal attributions vary on three primary dimensions: locus (internal/external), stability (stable/unstable), and controllability (controllable/uncontrollable). Given causal attributions can significantly impact behavior, specific beliefs about the cause of a particular disease likely strongly influence risk reduction behaviors relevant to that disease. Thus, understanding these causal beliefs, as well as factors that shape these beliefs, becomes a significant research goal. It is assumed that illness representations can be modified or shaped by exposure to various sources of information, as well as by personal and vicarious experience with a particular disease [8–11]. Previous research has examined causal beliefs regarding malignant disease. In general, this research has focused upon two related, but different, questions. Research has examined beliefs which cancer patients and survivors have regarding the cause of their own cancer [12–18]. Often, this research has sought to link personal causal beliefs to psychological adjustment in cancer patients and survivors [14, 18]. Other research has examined beliefs about the causes of cancer, in general. This research has studied causal beliefs held by both the general public [19–22] and individuals with a personal cancer history [11, 23–25]. Research regarding causal beliefs serves two purposes. First, this research can help identify links between specific causal beliefs and the practice of specific health behaviors, such as the practice of complementary anticancer therapies [23–24]. Second, this research can provide an empirical foundation for public health efforts to educate the public about causes of cancer and appropriate risk reduction behaviors. For example, causal beliefs of cancer survivors have been found to differ substantially from those of cancer experts [25], with cancer survivors underestimating the role of behavioral factors, such as physical inactivity and poor diet, and overestimating the role of environmental pollutants and stress. This research suggests that enhanced educational efforts are needed to ensure survivors are appropriately aware of cancer risk factors and to identify inappropriate causal beliefs requiring modification. Little attention has been devoted to identification of factors associated with causal beliefs, even though identification of factors associated with specific causal beliefs could shed light upon the development of these beliefs. In particular, little research has examined whether a personal or family history of cancer might be linked to causal beliefs about cancer. As both personal and vicarious experience with a particular disease can influence illness representations or causal attributions, a personal or family history of cancer could be expected to be associated with different causal beliefs. While no research has examined the impact of family history of cancer on causal attributions for cancer, multiple studies have compared the causal beliefs of individuals with and without a personal cancer history. Linn et al. [11] compared causal beliefs of late stage cancer patients to matched controls and found cancer patients consistently reported weaker beliefs about the role various causes played in cancer development, even when causes, such as smoking, were probably associated with the development of their own cancer. Similarly, Buick [26] found cancer patients held weaker beliefs about the role of internal and chance factors than did physically healthy women. Anagnostopoulos & Spanea [27] found breast cancer patients reported weaker beliefs about the role of environmental factors (e.g., pollution, chemical exposure) compared to controls without a history of breast cancer. Here, patients reported stronger beliefs about the role of chance and did not differ in the role of internal factors, such as personality or anxiety, when compared with controls. Thus, while specific findings regarding the influence of personal cancer history on causal attributions have been mixed, the overall pattern suggests a personal history of cancer tends to be associated with weaker causal beliefs. The weakening of causal beliefs, especially “controllable” attributions such as behavior or lifestyle factors, in cancer patients or survivors may be due to the need to defend oneself against blame from self or others as a means of coping with illness [11]. This is consistent with the notion that individuals tend to maintain causal beliefs that result in self-enhancement or beliefs of personal control. This is evidenced by research demonstrating individuals attribute causes for negative events externally and that people may attribute responsibility for negative events to event victims (consistent with the “just world hypothesis”), respectively [6]. As research has demonstrated breast cancer patients can be “double stigmatized,” both for having cancer and for causing their own cancer [26], it is not surprising that cancer patients might be motivated to protect themselves against blame for their own cancer. Using data from a large, population-based national survey, the present study examines the relationship between personal and family history of cancer and beliefs about the causes of cancer. Based on previous research, and consistent with the notion that causal attributions can play a self-protective role, we hypothesize individuals with a personal history of cancer will report weaker beliefs about the role played by specific causes in cancer development. Additionally, we hypothesize a family history of cancer, alone or in combination with a personal cancer history, should influence beliefs about the causes of cancer. A directional hypothesis is not made at this time due to lack of previous investigations and the diverging directionality that would be predicted by attributions designed to protect close others (weaker beliefs) or to maintain beliefs in personal control (stronger beliefs). Given the potential link between causal beliefs and subsequent cancer risk reduction behaviors, basic research identifying how causal attributions vary as a function of personal and/or family history of cancer could assist future public health efforts to target cancer risk reduction messages to appropriate audiences.