What do people fear about cancer? A systematic review and meta-synthesis

Abstract

BackgroundCancer has long inspired fear but the effect of fear on early detection behaviours is not well understood. Quantitative studies suggest a complex association, with fear seeming both to facilitate and to deter early diagnosis behaviours. These inconsistencies might be partly due to the use of general measures that fail to consider whether fear of cancer has many dimensions. The aim of this study was to systematically review and synthesise the qualitative literature to explore the concept of fear of cancer. MethodsWe searched Medline, Embase, PsychINFO, Web of Science, and Anthrobase from Jan 1, 1992, to June 1, 2013, for qualitative studies published in English using the search terms “cancer” and “fear or worry or anxiety” and “breast or colorectal or cervical cancer screening”. Study quality was assessed but not used as a selection criterion. We took an inclusive approach to extract quotations and authors' interpretations. These excerpts were annotated and discussed among the authors to generate early themes, which were then synthesised into a higher order structure. Findings78 studies from 23 countries were included (USA 46 [59%], UK 9 [12%], Australia 3 [4%]). Most studies involved breast cancer (41%), followed by colorectal cancer (26%), cervical cancer (23%), or more than one type of cancer (10%). Fears of cancer emanated from a core view of cancer as an unpredictable and indestructible enemy. This enemy evoked four types of fear: fears about its proximity, fears about the (lack of) strategies to keep it at a distance, fears about the personal and social implications of succumbing, and fear of dying from the disease. InterpretationThis qualitative meta-synthesis drew out the multidimensionality of fear of cancer with a view of cancer as an enemy at its core, thus reprising the war-on-cancer theme that dominates the media. This enemy has various characteristics that could influence whether fight or flight is most appropriate. The view of cancer as an unpredictable and external threat can discredit messages about early detection, or impede the adoption of preventive health behaviours; future policies should focus on removing mixed messages in the public portrayal of cancer. Although only three types of cancer screening were included, evidence exists for similar fears in other populations. FundingThis research was supported by a programme grant from Cancer Research UK to JWar (C1418/A14134). Cancer Research UK was not involved in the design of this study; the collection, analysis, and interpretation of the results; the write-up of the results; or in the decision to submit for publication. This abstract was not commissioned by a pharmaceutical company or other agency. CV had full access to all the data in the study and had the final responsibility for the decision to submit for publication.