Only two in five people (42%) are confident about recognizing the changes to their breasts that could be a sign of cancer, according to a new survey of 19,000 respondents by Avon Products, Inc. The findings also show there is a knowledge gap amongst women globally about what the symptoms are for breast cancer and how to lower the risk of developing the disease.

The World Health Organization estimates that breast cancer kills more than 500,000 women globally every year, a number that could be greatly reduced if cancer were detected at an earlier stage.

Despite 73% of respondents saying they look out for changes to the appearance of their breasts, many report that they aren’t confident recognizing the early signs of breast cancer. Moreover, more than half of those surveyed (60%) would hesitate to seek medical advice for a variety of reasons, including embarrassment, fear and not having access to a regular doctor.

The survey also found a lack of know-ledge when it comes to identifying signs and knowing the risks of breast cancer, which may be due to a lack of information – 30% said that they haven’t been given any information about changes to their breasts that could be a cause for concern. A quarter (25%) think that a lump is the only sign of breast cancer that can be identified without medical equipment. When asked to identify 10 common symptoms of breast cancer, only 2% managed to select all 10 correctly.

There is also low awareness of some of the important lifestyle factors that could prevent breast cancer, with almost two-thirds (64%) unaware that exercise could help lower the risk of developing breast cancer. Similarly, 63% of those surveyed do not know that alcohol consumption is linked to a higher risk of breast cancer.

The research comes as Avon launches its new Breast Cancer Promise, a renewed multi-year commitment to educating women about breast health that builds on its legacy of supporting the breast cancer cause.