An analysis of almost 2,000 adults sent invitations for cancer screening shows that different reasons for cancer fear result in different responses to check-ups, with worried people wanting the test but not actually going for it.

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Worries about cancer drove people to want a check up, but when it came to actually attending, a more visceral feeling of fear took over and stopped them.

The study analyzed participants from the UK Flexible Sigmoidoscopy Trial and is published online in the American Association for Cancer Research’s journal Cancer Epidemiology, Biomarkers & Prevention.

The lead author is Charlotte Vrinten, a research psychologist for the health behavior research centre at University College London in the UK. She explains:

“Many people are afraid of getting cancer, but fear doesn’t have the same effect on everyone.

“For some people, cancer fear motivates them to get checked up; for others, it puts them off from finding out whether they have cancer.”

Previous research on the way cancer screening is affected by fear has failed to unpack the individual components of the worry, Vrinten says. Her study is the first to examine the following three components of cancer fear:

  • “I worry a lot about cancer” (frequent worries, a component of fear called affective response)
  • “Of all the diseases there are, I am most afraid of cancer” (cognitive evaluation)
  • “It makes me uncomfortable to think about cancer” (psychobiological feeling).

The question of why people’s fears lead some to get screened yet others to avoid the issue had not been elucidated in this way before.

“No one before has worked out why fear might have such opposite effects,” Vrinten says. “In our study, instead of using a combined measure of cancer fear, as is often done, we distinguished different aspects of fear to see whether they had different effects on people’s decisions about cancer screening.”

The results showed that people who worried about cancer (the “affective” component of cancer fear) were more likely to want to get screened for colon cancer.

But a different component of fear in the same people, a feeling of discomfort at the thought of cancer (the “psychobiological” component), made them less likely to act on their worry-based desire for screening – less likely to actually attend the screening test.

People who worried frequently about cancer were more likely to have a desire to get screened for colon cancer, but those who felt uncomfortable thinking about cancer were 12% less likely to attend screening, the study found.

In relation to the group who had the visceral discomfort when thinking about cancer, Vrinten says “12% may not seem like a lot, but given that tens of thousands of people [in the UK] are eligible for this type of screening, it means a big difference in the number of people actually attending.” She adds:

Public campaigns often focus on increasing public fear about cancer, for example, by emphasizing how common cancer is or how deadly some types of cancer are.

This might put some people off, rather than motivate them to get screened.”

Rather than scare people, public information about endoscopic screening for colon cancer, Vrinten says, should focus instead on how this sort of check-up can “can actually prevent colon cancer, so having the test can mean they have one less cancer to worry about.”

Fear of cancer remains a common problem, the study suggests:

  • More than half of participants said they felt uncomfortable when thinking about cancer
  • About a quarter worried a lot about cancer.

Nearly 2,000 participants were randomized to receive an invitation for an actual screening appointment, from the full study of just under 8,000 adults in the UK aged between 55 and 64 years who had been sent questionnaires about their screening intentions.

A follow-up of clinical records showed that a total of 71% of the invited group actually attended:

  • Of those who felt uncomfortable thinking about cancer, 68% attended screening
  • Of those who did not feel such discomfort, attendance was higher at 77%.

Against the initial questionnaires answered by nearly 8,000 people, 82% responded that they would either probably or definitely take up an offer of colorectal cancer screening, and overall:

  • 59% said they were more afraid of cancer than of other diseases
  • 53% agreed that they felt uncomfortable thinking about cancer, and
  • 25% worried a lot about cancer – and were more likely to want to attend screening than non-worriers.

The study was sponsored by the British cancer research non-profit Cancer Research UK.

A study published last April in JAMA Internal Medicine found that women who needed additional breast cancer screening tests because initial mammography had thrown up a falsely positive result did not suffer long-term anxiety about screening tests. See: Anxiety over false-positive mammogram results is ‘only temporary.’

News in August reported that certain state-specific reimbursement and eligibility policies affected the uptake of screening tests for breast, cervical and colorectal cancers. See: Medicaid: do differing state reimbursement policies affect cancer screening?