Dimensions of cancer fear in the screening context: a qualitative synthesis


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Charlotte Vrinten1, Georgia Black1, Lesley McGregor1, Malgorzata Heinrich1, Christian von Wagner1, Jo Waller1, Jane Wardle1
1University College London, London, UK


Fear of cancer is widely agreed to be an important determinant both of screening participation and symptomatic presentation. However, quantitative analyses suggest a complex relationship, with fear appearing to facilitate early diagnosis behaviours, deter them, or both, across different studies. These inconsistencies may be due partly to the use of general measures of cancer fear which fail to distinguish the different dimensions. The aim of this study was to synthesise the qualitative literature on cancer fear in the context of cancer screening and categorise the dimensions manifested in these studies.


We searched Medline, Embase, PsychInfo, Web of Science and Anthrobase (1992-2012) for qualitative studies on fear in the cancer screening context. Studies were assessed for quality and methodology, although we did not exclude any on this basis. Quotations and authors' interpretations were extracted from included studies, and these were analysed and interpreted through meta-synthesis.


Seventy-one studies from 22 countries were included: the majority were conducted in the US (59%), UK (11%) and Australia (4%). Most studies involved breast cancer (43%), with smaller numbers in colorectal (25%), cervical (21%), or more than one cancer site (11%). The most common methods of data collection were focus groups (36 studies) and interviews (25). In many studies, fear of cancer manifested as an unspecified dread as if there was no further reason to explain. In addition, fear of death, fear of treatment, fear of the effects of a cancer diagnosis on family and friends, and fear of the screening test each emerged as specific aspects of fear across several studies.


This qualitative synthesis suggests that the cancer fear construct has several dimensions. Recognition of the multidimensional nature may help quantitative researchers develop more comprehensive measures of cancer fear, and potentially clarify relationships between fear and screening uptake.