Motivation and emotion/Book/2026/Cancer screening and emotion

Cancer screening and emotion:
How do emotions such as fear, anxiety, and relief influence cancer screening uptake?

Overview

Figure 1. A woman undergoing a standard mammogram procedure. Scenario Megan, 50, discovers a letter in her mailbox inviting her a routine mammogram. She has continuously delayed it for the last four years. Her mother passed as a result of breast cancer, and the mere thought of the appointment makes her stomach knot. A part of her is comfortable with the uncertainty. The letter lays within a draw. In contrast, her friend Stella obtains the same letter a week later. Stella promptly schedules her appointment, Stella's view is synonymous with taking responsibility of her health. The procedure is the same, the same risk is attributed. Consequently, they feel completely differently about it and make opposite decisions.

Cancer screening programs for instance mammography, cervical screening, and bowl screening can significantly reduce mortality through early detection. Conversely, engagement remains below established national targets in Australia and internationally (Australian Institute of Health and Welfare, 2026).

Key points this chapter develops:

• Recognising these emotional dynamics attributes to screening programs to develop communication strategies that improve uptake.
• Individuals decision to participate in screening are not soley driven by rational evaluation; anxiety, fear, embarrassment, are all determinants as to whether individuals par take (Consedine et al., 2004)

Focus questions How can emotional determinants be addressed to improve screening participation? What is the role of relief as an emotional driver in the uptake of screening? What emotions are experienced in relation to cancer screening? How does anxiety and fear act as barriers to screening uptake?

What emotions are involved in cancer screening?

• Emotional responses to screening comprise fear, anxiety, worry, stress, broadly conceptualised as anticipatory anxiety (Goodwin et al.,2023)
• Concern around the screening procedure and the cancer itself was reported between 10-50% of participants (Goodwin et al.,2023)
• A review of 74 studies identified that diagnostic anxiety tended to promote screening, conversely, procedural fear was almost reliably discouraging it (Goodwin et al., 2023).

How does anxiety and fear motivate cancer screening?

• Evidence from a systematic review illustrated that anxiety of a possible cancer diagnosis was often linked to greater screening uptake. Conversely, the fear of procedure discouraged participation (Goodwin et al.,2023).
• In a large Australian sample, screening engagement increased as an anxiety also increased but when anxiety was severe individuals were less likely to engage in screening (Anderson et al.,2023).
• Protection Motivation Theory proposes that individuals are highly probable to screen when they feel at harm and believe screening will benefit (Rogers, 1975).

How does anxiety and fear act as barriers in cancer screening uptake?

• Fear of receiving screening results can undermine participation, with fear of receiving a positive result as one of the biggest discouragers of cervical screening among Australian women (Nagendiram et al., 2020).
• Severe anxiety may mitigate screening participation, with Australian literature illustrating lower bowel cancer screening participation across individuals experiencing severe anxiety (Anderson et al., 2023).
• Anticipatory anxiety associated around the screening procedure can attribute to avoidance, with never-screened or under screened Australian's noting psychological distress accompanied by invasive and sometimes discomfort-inducing nature of cervical screening (Creagh et al., 2021).

Conclusion

• The behavioural impacts of emotional responses on screening uptake, anxiety and fear proficient discouraging and motivating screening participation shaped by their focus and intensity
• Developing greater insight into the emotional components shaping screening decisions, guiding he development of strategies to mitigate psychological barriers promoting greater engagement
• Anxiety and fear influence screening in multifaceted ways, illustrating that emotional processes collectively shape screening behaviour.

References

Anderson, L. E., Ireland, M. J., Myers, L., Avenell, C., Connaughton, T., & Goodwin, B. C. (2023). Psychological distress and bowel cancer screening participation. Psycho-Oncology, 32(2), 229–236. https://doi.org/10.1002/pon.6072

Australian Institute of Health and Welfare. (2026). Cancer screening. Australian Government. https://www.aihw.gov.au/reports/australias-health/cancer-screening-and-treatment

Consedine, N. S., Magai, C., Krivoshekova, Y. S., Ryzewicz, L., & Neugut, A. I. (2004). Fear, anxiety, worry, and breast cancer screening behavior: A critical review. Cancer Epidemiology, Biomarkers & Prevention, 13(4), 501–510. https://doi.org/10.1158/1055-9965.501.13.4

Creagh, N. S., Zammit, C., Brotherton, J. M. L., Saville, M., McDermott, T., Nightingale, C., & Kelaher, M. (2021). Self-collection cervical screening in the renewed National Cervical Screening Program: A qualitative study. Medical Journal of Australia, 215(8), 354–358. https://doi.org/10.5694/mja2.51137

Goodwin, B. C., Anderson, L., Collins, K., Sanjida, S., Riba, M., Singh, G. K., Campbell, K. M., Green, H., Ishaque, S., Kwok, A., Opozda, M. J., Pearn, A., Shaw, J., Sansom-Daly, U. M., Tsirgiotis, J. M., Janda, M., & Grech, L. (2023). Anticipatory anxiety and participation in cancer screening: A systematic review. Psycho-Oncology, 32(12), 1773–1786. https://doi.org/10.1002/pon.6238

Nagendiram, A., Bougher, H., Banks, J., Hall, L., & Heal, C. (2020). Australian women's self-perceived barriers to participation in cervical cancer screening: A systematic review. Health Promotion Journal of Australia, 31(3), 343–353. https://doi.org/10.1002/hpja.280

Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. The Journal of Psychology, 91(1), 93–114. https://doi.org/10.1080/00223980.1975.9915803