Research suggests that fear plays a major role in deciding whether to get tested for cancer.
Kelly Ackerson, PhD, of Western Michigan University and colleagues used decision theory from economics and psychology to investigate why some women do not seek screening for breast and cervical cancer.
The researchers state, “Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women’s choices to improve adherence.”
They looked at 19 research papers which covered 5,991 women, were published from 1994 to 2008, and recorded the reasons for undergoing cancer screening in each case. Analysis showed, “All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios.”
Ackerson commented, “Our review showed that fear could motivate women to either seek screening or to avoid screening. Some women complied because they feared the disease and saw screening as routine care, but other women feared medical examinations, health care providers, tests and procedures and didn’t seek screening if their health was good.
“Lack of information was a big barrier. It was clear from our review that very few women understood that cervical smear testing aims to identify abnormal cells before they become malignant and that breast screening can detect cancer in the early stages when treatment is most effective.”
The researchers conclude that nurses need to address women’s fears and misconceptions about breast and cervical cancer screening “by openly and uniformly discussing the importance and benefits.”
In 2007 the Centers for Disease Control and Prevention estimated that 25 percent of women over age 40 had not had breast screening in the last two years and 16 percent aged 18 and over had not had a cervical smear in the last three years.
Nathan S. Consedine, PhD, of the Intercultural Institute on Human Development and Aging, in Brooklyn, N.Y., points out that anxiety, worry, and fear are common emotional responses to the threat of disease.
He studied the role of anxiety in prostate screening, looking at the link between an individual’s general anxiety, worries about cancer, and screening fear, in relation to prostate-specific antigen (PSA) tests and digital rectal examination (DRE).
“Fears regarding prostate cancer and the associated screening are widespread,” Consedine writes. “However, the relations between anxiety, cancer worry, and screening fear and screening behavior are complex, because anxieties stemming from different sources have different effects on behavior.”
He recruited 533 men aged 45 to 70 years, who completed measures of trait anxiety, cancer worry, and screening fear. As expected, likelihood of having had a DRE or PSA test was associated with cancer worry and screening fear. Cancer worry was associated with more frequent screening, but fear of screening was associated with less frequent screening, particularly DRE. This rectal examination is more intrusive than the PSA blood test. The link with trait anxiety was inconsistent.
Consedine says it is critical to distinguish between these types of anxiety, so physicians can know the source and content of the patient’s fears. Cancer worry is associated with more frequent screening because (rightly or wrongly) men anticipate that their anxiety will reduce after screening, or are seeking peace of mind. However, fear of screening causes men to avoid the situation.
He writes, “The underlying theory regarding the importance of anxiety source is likely to generalize to other cancer screens and other health behaviors. Indeed, given the extent to which anxieties surround diagnosis, detection, and treatment of many leading diseases, identifying the source of fears in different disease contexts would seem an obvious next step.”
This will lead to better interventions to encourage health-promoting behavior, he believes.
There is a debate over the use of fear (emphasizing severe threats to health) to encourage preventive health behaviors such as screening for cancer. Professor Sandra C. Jones of the University of Wollongong, Australia, looked at the effects of this approach.
She writes, “While it has been found that appeals to fear may result in attitude and behavior change, there is also the risk of inciting inappropriate levels of fear or instigating maladaptive behavior such as denial or defensive avoidance.”
In a 2006 study, she examined the impact of a “threat manipulation” for mammography screening on a group of women. Varying the level of threat had no impact on the women’s intentions to undergo mammography. But high-threat messages resulted in stronger negative emotional reactions and greater perceived susceptibility among younger women, who are not the target group for screening.
The results warn against using high levels of threat, and indicate that campaigns need to be designed to specifically affect and motivate the target group, she concludes.
Ackerson, K. and Preston, S. A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. The Journal of Advanced Nursing, Vol. 65, June 2009, pp. 1130-40.
Consedine, N. S. et al. An object lesson: source determines the relations that trait anxiety, prostate cancer worry, and screening fear hold with prostate screening frequency. Cancer Epidemiology, Biomarkers and Prevention, Vol. 17, July 2008, pp. 1631-39.
Jones, S. C. and Owen, N. Using fear appeals to promote cancer screening – are we scaring the wrong people? International Journal of Nonprofit and Voluntary Sector Marketing, Vol. 11, May 2006, pp. 93-103.