Among young adults (20–39), cancer is the fifth leading cause of death. Delayed diagnoses in this population are frequent, contributing to reduced survival and higher morbidity. Delays may be driven by individuals attributing symptoms as nonserious and failing to seek timely medical care. Google search is commonly used for health information seeking, but we do not know the current online symptom content quality that young adults may encounter.
Purpose:
We aimed to answer 1. What is the content quality of top-ranked webpages for common young adult cancer symptom searches? 2. Does quality differ by website type (e.g., academic/health care vs. for profit)?
Methods:
Using 18 young adult cancer symptoms as input into the SEMRush Keyword Magic Tool, we generated a list of the most common keyword searches and the top-ranked webpages (i.e., first three pages listed in Google output). We evaluated 162 pages on 9 quality metrics, including the JAMA benchmark criteria.
Results:
Two-thirds of pages (66.7%, n = 108) were written at less than a 9th-grade reading level, and three-quarters (72.8%, n = 118) provided actionable content about when to seek medical care for symptoms. However, only 13.6% (n = 22) of pages included content framed for young adults. On average, pages met about half (2.33) of four JAMA criteria (authorship, disclosures, currency/up-to-date, and references).
Conclusion:
Academic/health and government organizations should devote resources to improving information about young adult cancer symptoms on their webpages and optimize these pages to appear higher in search result rankings.
American Cancer Society. Special Section: Cancer in Adolescents and Young Adults. American Cancer Society; 2020.
2.
MillerKD, Fidler-BenaoudiaM, KeeganTH, et al.Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin2020;70(6):443–459; doi: 10.3322/caac.21637
3.
BleyerA. Increasing cancer in adolescents and young adults: Cancer types and causation implications. J Adolesc Young Adult Oncol2023;12(3):285–296; doi: 10.1089/jayao.2022.0134
4.
Centers for Disease Control and Prevention NCfIPaC. WISQARS Leading Causes of Death Visualization Tool. Available from: https://wisqars.cdc.gov/lcd/ [Last accessed: August2, 2025].
5.
BleyerA, BarrR. Cancer in young adults 20 to 39 years of age: Overview. Semin Oncol2009;36(3):194–206; doi: 10.1053/j.seminoncol.2009.03.003
6.
KooMM, LyratzopoulosG, HerbertA, et al.Association of self-reported presenting symptoms with timeliness of help-seeking among adolescents and young adults with cancer in the BRIGHTLIGHT Study. JAMA Netw Open2020;3(9):e2015437; doi: 10.1001/jamanetworkopen.2020.15437
7.
ForsterAS, HerbertA, KooMM, et al.Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: Cross-sectional analysis of the BRIGHTLIGHT cohort. Br J Cancer2022;126(12):1725–1734; doi: 10.1038/s41416-022-01698-6
8.
HerbertA, LyratzopoulosG, WhelanJ, et al.Diagnostic timeliness in adolescents and young adults with cancer: A cross-sectional analysis of the BRIGHTLIGHT cohort. Lancet Child Adolesc Health2018;2(3):180–190.
9.
DommettRM, PringH, CargillJ, et al.Achieving a timely diagnosis for tagers and young adults with cancer: The ACE “too young to get cancer?” study. BMC Cancer2019;19(1):616.
10.
MillerKA, StalJ, GallagherP, et al.Time from diagnosis and correlates of health-related quality of life among young adult colorectal cancer survivors. Cancers (Basel)2021;13(16):4045; doi: 10.3390/cancers13164045
11.
BarrRD, FerrariA, RiesL, et al.Cancer in adolescents and young adults: A narrative review of the current status and a view of the future. JAMA Pediatr2016;170(5):495–501; doi: 10.1001/jamapediatrics.2015.4689
12.
FidlerMM, GuptaS, SoerjomataramI, et al.Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: A population-based study. Lancet Oncol2017;18(12):1579–1589; doi: 10.1016/s1470-2045(17)30677-0
13.
BellizziKM, SmithA, SchmidtS, Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Study Collaborative Group. et al.Positive and negative psychosocial impact of being diagnosed with cancer as an adolescent or young adult. Cancer2012;118(20):5155–5162; doi: 10.1002/cncr.27512
14.
ChaoC, BhatiaS, XuL, et al.Incidence, risk factors, and mortality associated with second malignant neoplasms among survivors of adolescent and young adult cancer. JAMA Netw Open2019;2(6):e195536; doi: 10.1001/jamanetworkopen.2019.5536
15.
ChaoC, XuL, BhatiaS, et al.Cardiovascular Disease Risk Profiles in Survivors of Adolescent and Young Adult (AYA) Cancer: The Kaiser permanente AYA Cancer Survivors Study. J Clin Oncol2016;34(14):1626–1633; doi: 10.1200/jco.2015.65.5845
16.
LeeJS, DuBoisSG, CocciaPF, et al.Increased risk of second malignant neoplasms in adolescents and young adults with cancer. Cancer2016;122(1):116–123; doi: 10.1002/cncr.29685
17.
OlssonM, SteineckG, EnskärK, et al.Sexual function in adolescent and young adult cancer survivors—a population-based study. J Cancer Surviv2018;12(4):450–459; doi: 10.1007/s11764-018-0684-x
18.
BishA, RamirezA, BurgessC, et al.Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res2005;58(4):321–326.
19.
WalterF, WebsterA, ScottS, et al.The Andersen Model of Total Patient Delay: A systematic review of its application in cancer diagnosis. J Health Serv Res Policy2012;17(2):110–118; doi: 10.1258/jhsrp.2011.010113
20.
ScottSE, WalterFM, WebsterA, et al.The model of pathways to treatment: Conceptualization and integration with existing theory. Br J Health Psychol2013;18(1):45–65; doi: 10.1111/j.2044-8287.2012.02077.x
21.
AndersenBL, CacioppoJT. Delay in seeking a cancer diagnosis: Delay stages and psychophysiological comparison processes. Br J Soc Psychol1995;34(Pt 1):33–52; doi: 10.1111/j.2044-8309.1995.tb01047.x
22.
MoodleyJ, CairncrossL, NaikerT, et al.From symptom discovery to treatment—Women’s pathways to breast cancer care: A cross-sectional study. BMC Cancer2018;18(1):312; doi: 10.1186/s12885-018-4219-7
23.
Quinn-ScogginsHD, Cannings-JohnR, MoriartyY, et al.Cancer symptom experience and help-seeking behaviour during the COVID-19 pandemic in the UK: A cross-sectional population survey. BMJ Open2021;11(9):e053095.
24.
HamiltonW, WalterFM, RubinG, et al.Improving early diagnosis of symptomatic cancer. Nat Rev Clin Oncol2016;13(12):740–749; doi: 10.1038/nrclinonc.2016.109
25.
FordPJ, FarahCS. Early detection and diagnosis of oral cancer: Strategies for improvement. J Cancer Policy2013;1(1–2):e2–e7; doi: 10.1016/j.jcpo.2013.04.002
26.
VenchiaruttiRL, PhoL, ClarkJR, et al.A qualitative exploration of the facilitators and barriers to early diagnosis and treatment of head and neck cancer: Perceptions of patients and carers. Eur J Cancer Care (Engl)2022;31(6):e13718; doi: 10.1111/ecc.13718
27.
MiedemaBB, EasleyJ, HamiltonR. Young adults’ experiences with cancer: Comments from patients and survivors. Can Fam Physician2006;52(11):1446–1447.
28.
HartRI, CowieFJ, JesudasonAB, et al.Adolescents and young adults’ (AYA) views on their cancer knowledge prior to diagnosis: Findings from a qualitative study involving AYA receiving cancer care. Health Expect2021;24(2):307–316; doi: 10.1111/hex.13170
29.
GibsonF, PearceS, EdenT, et al.Young people describe their prediagnosis cancer experience. Psychooncology2013;22(11):2585–2592; doi: 10.1002/pon.3325
30.
KentEE, ParryC, MontoyaMJ, et al.“You’re too young for this”: Adolescent and young adults’ perspectives on cancer survivorship. J Psychosoc Oncol2012;30(2):260–279; doi: 10.1080/07347332.2011.644396
31.
US Department of Health and Human Services. Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancer. Report of the Adolescent and Young Adult Oncology Progress Review Group. US Department of Health and Human Services: 2006.
32.
WhiteRW, HorvitzE. Cyberchondria: Studies of the escalation of medical concerns in web search. ACM Trans Inf Syst2009;27(4):1–37.
33.
AounL, LakkisN, AntounJ. Prevalence and outcomes of web-based health information seeking for acute symptoms: Cross-sectional study. J Med Internet Res2020;22(1):e15148.
34.
AveryN, GhandiJ, KeatingJ. The ‘Dr Google’ phenomenon–missed appendicitis. N Z Med J2012;125(1367):135–137.
35.
Bujnowska-FedakMM, WęgierekP. The impact of online health information on patient health behaviours and making decisions concerning health. Int J Environ Res Public Health2020;17(3):880.
36.
KuehnBM. More than one-third of US individuals use the Internet to self-diagnose. JAMA2013;309(8):756–757.
37.
MarcuA, MullerC, ReamE, et al.Online information-seeking about potential breast cancer symptoms: Capturing online behavior with an internet browsing tracking tool. J Med Internet Res2019;21(2):e12400; doi: 10.2196/12400
38.
HochbergI, AllonR, Yom-TovE. Assessment of the frequency of online searches for symptoms before diagnosis: Analysis of archival data. J Med Internet Res2020;22(3):e15065; doi: 10.2196/15065
39.
CroccoAG, Villasis-KeeverM, JadadAR. Analysis of cases of harm associated with use of health information on the internet. JAMA2002;287(21):2869–2871.
40.
FridmanI, JohnsonS, Elston LafataJ. Health information and misinformation: A framework to guide research and practice. JMIR Med Educ2023;9:e38687; doi: 10.2196/38687
41.
WangX, ShiJ, KongH. Online health information seeking: A review and meta-analysis. Health Commun2021;36(10):1163–1175; doi: 10.1080/10410236.2020.1748829
42.
Swire-ThompsonB, LazerD. Public health and online misinformation: Challenges and recommendations. Annu Rev Public Health2020;41(1):433–451.
43.
SuziedelyteA. How does searching for health information on the Internet affect individuals’ demand for health care services? Soc Sci Med2012;75(10):1828–1835; doi: 10.1016/j.socscimed.2012.07.022
44.
JiaX, PangY, LiuLS. Online health information seeking behavior: A systematic review. MDPI2021.
45.
MuellerJ, JayC, HarperS, et al.Web use for symptom appraisal of physical health conditions: A systematic review. J Med Internet Res2017;19(6):e202; doi: 10.2196/jmir.6755
46.
MuellerJ, JayC, HarperS, et al.The role of web-based health information in help-seeking behavior prior to a diagnosis of lung cancer: A mixed-methods study. J Med Internet Res2017;19(6):e189; doi: 10.2196/jmir.6336
AllardNC, OromH. Examining beliefs and information-seeking behaviors of young adults aged 20-39 to help inform cancer prevention communication. Unpublished Manuscript2022.
49.
AmanteDJ, HoganTP, PagotoSL, et al.Access to care and use of the internet to search for health information: Results from the US National Health Interview Survey. J Med Internet Res2015;17(4):e106; doi: 10.2196/jmir.4126
50.
HunsakerA, HargittaiE, MicheliM. Relationship between internet use and change in health status: Panel study of young adults. J Med Internet Res2021;23(1):e22051; doi: 10.2196/22051
51.
AllardNC, BouchardEG, FordJS, et al.Understanding symptom appraisal, help-seeking, and diagnostic delays in young adult cancer: A qualitative study guided by the model of pathways to treatment. Cancer Causes Control.
52.
ThomsonMD, SiminoffLA, LongoDR. Internet use for prediagnosis symptom appraisal by colorectal cancer patients. Health Educ Behav2012;39(5):583–588; doi: 10.1177/1090198111423941
53.
McTavishJ, HarrisR, WathenN. Searching for health: The topography of the first page. Ethics Inf Technol2011;13(3):227–240; doi: 10.1007/s10676-011-9272-8
54.
NandaJK, HayJL, MarchettiMA. Analysis of keywords used in internet searches for melanoma information: Observational study. JMIR Dermatol2021;4(1):e25720; doi: 10.2196/25720
55.
AndrzejewskiJ, RasberryCN, MustanskiB, et al.Sexual and reproductive health web sites: An analysis of content for sexual and gender minority youth. Am J Health Promot2020;34(4):393–401; doi: 10.1177/0890117119899217
56.
HopkinsZH, SecrestAM. Public health implications of Google searches for sunscreen, sunburn, skin cancer, and melanoma in the United States. Am J Health Promot2019;33(4):611–615; doi: 10.1177/0890117118811754
57.
FerreiraG, TraegerAC, MachadoG, et al.Credibility, accuracy, and comprehensiveness of internet-based information about low back pain: A systematic review. J Med Internet Res2019;21(5):e13357; doi: 10.2196/13357
58.
AlexanderS, SeenanC. Credibility, accuracy, and comprehensiveness of readily available internet-based information on treatment and management of peripheral artery disease and intermittent claudication: Review. J Med Internet Res2022;24(10):e39555; doi: 10.2196/39555
59.
ȘuleaCM, NădășanV, UrsachiT, et al.What patients find on the internet when looking for information about percutaneous coronary intervention: Multilanguage cross-sectional assessment. J Med Internet Res2022;24(12):e41219; doi: 10.2196/41219
60.
SalehD, FisherJH, ProvencherS, et al.A systematic evaluation of the quality, accuracy, and reliability of internet websites about pulmonary arterial hypertension. Ann Am Thorac Soc2022;19(8):1404–1413.
61.
JonesJ, CassieS, ThompsonM, et al.Delivering healthcare information via the internet: Cardiac patients’ access, usage, perceptions of usefulness, and web site content preferences. Telemed J E Health2014;20(3):223–227; quiz 228.
62.
MontonO, LambertS, BelzileE, et al.An evaluation of the suitability, readability, quality, and usefulness of online resources for family caregivers of patients with cancer. Patient Educ Couns2019;102(10):1892–1897.
63.
StviliaB, MonL, YiYJ. A model for online consumer health information quality. J Am Soc Inf Sci2009;60(9):1781–1791.
64.
MasoniM, GuelfiMR. Evaluating online health information in terms of readability, understandability and actionability. Form@re2020;20(1):356–367.
65.
KloosterboerA, YannuzziNA, PatelNA, et al.Assessment of the quality, content, and readability of freely available online information for patients regarding diabetic retinopathy. JAMA Ophthalmol2019;137(11):1240–1245.
66.
GuoW-J, WangW-K, XuD, et al.Evaluating the quality, content, and readability of online resources for failed back spinal surgery. Spine (Phila Pa 1976)2019;44(7):494–502.
67.
RiordainRN, McCrearyC. Head and neck cancer information on the internet: Type, accuracy and content. Oral Oncol2009;45(8):675–677.
68.
CorcellesR, DaigleCR, TalamasHR, et al.Assessment of the quality of Internet information on sleeve gastrectomy. Surg Obes Relat Dis2015;11(3):539–544.
69.
Cuan-BaltazarJY, Muñoz-PerezMJ, Robledo-VegaC, et al.Misinformation of COVID-19 on the Internet: Infodemiology Study. JMIR Public Health Surveill2020;6(2):e18444; doi: 10.2196/18444
70.
FuLY, ZookK, Spoehr-LabuttaZ, et al.Search engine ranking, quality, and content of web pages that are critical versus noncritical of human papillomavirus vaccine. J Adolesc Health2016;58(1):33–39; doi: 10.1016/j.jadohealth.2015.09.016
71.
PennycookG, EpsteinZ, MoslehM, et al.Understanding and reducing the spread of misinformation online. ArXiv2019:1–84.
72.
ClaggettJ, KitchensB, PainoM, et al.The effects of website traits and medical skepticism on patients’ willingness to follow web-based medical advice: Web-based experiment. J Med Internet Res2022;24(2):e29275; doi: 10.2196/29275
73.
SunY, ZhangY, GwizdkaJ, et al.Consumer evaluation of the quality of online health information: Systematic literature review of relevant criteria and indicators. J Med Internet Res2019;21(5):e12522; doi: 10.2196/12522
74.
KimP, EngTR, DeeringMJ, et al.Published criteria for evaluating health related web sites: Review. BMJ1999;318(7184):647–649; doi: 10.1136/bmj.318.7184.647
75.
SilbergWM, LundbergGD, MusacchioRA. Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor—Let the reader and viewer beware. JAMA1997;277(15):1244–1245.
76.
BerlandGK, ElliottMN, MoralesLS, et al.Health information on the Internet: Accessibility, quality, and readability in English and Spanish. JAMA2001;285(20):2612–2621; doi: 10.1001/jama.285.20.2612
77.
Wrigley KellyNE, MurrayKE, McCarthyC, et al.An objective analysis of quality and readability of online information on COVID-19. Health Technol (Berl)2021;11(5):1093–1099; doi: 10.1007/s12553-021-00574-2
78.
KreuterMW, WrayRJ. Tailored and targeted health communication: Strategies for enhancing information relevance. Am J Health Behav2003;27(Suppl 3):S227–S32; doi: 10.5993/ajhb.27.1.s3.6
79.
BleyerA. CAUTION! Consider cancer: Common symptoms and signs for early detection of cancer in young adults. Semin Oncol2009;36(3):207–212; doi: 10.1053/j.seminoncol.2009.03.004
LaValleySA, KiviniemiMT, Gage-BouchardEA. Where people look for online health information. Health Info Libr J2017;34(2):146–155; doi: 10.1111/hir.12143
82.
MerrellRC, ConeSW, RafiqA. The authority and utility of Internet information. Stud Health Technol Inform2008;131:265–272.
83.
BermanR, KatonaZ. The role of search engine optimization in search marketing. Marketing Sci2013;32(4):644–651.
84.
DunneS, CumminsNM, HanniganA, et al.A method for the design and development of medical or health care information websites to optimize search engine results page rankings on Google. J Med Internet Res2013;15(8):e183.
85.
CotugnaN, VickeryCE, Carpenter-HaefeleKM. Evaluation of literacy level of patient education pages in health-related journals. J Community Health2005;30(3):213–219; doi: 10.1007/s10900-004-1959-x
FulopT, LarbiA, WitkowskiJM, et al.Aging, frailty and age-related diseases. Biogerontology2010;11(5)(:547–563.
88.
CoronaG, MannucciE, RiccaV, et al.The age‐related decline of testosterone is associated with different specific symptoms and signs in patients with sexual dysfunction. Int J Androl2009;32(6):720–728.
ImranM, AlmusharrafN. Google Gemini as a next generation AI educational tool: A review of emerging educational technology. Smart Learn Environ2024;11(1):22.
91.
LamprellK, PulidoDF, ArnoldaG, et al.People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia and New Zealand. BMC Prim Care2023;24(1):12; doi: 10.1186/s12875-023-01967-0
92.
FritzCDL, OtegbeyeEE, ZongX, et al.Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. J Natl Cancer Inst2023;115(8):909–916; doi: 10.1093/jnci/djad068
93.
National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral. NICE: London; 2015.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
