Lay Beliefs About the Accuracy and Value of Cancer Screening


      Appreciating the accuracy and value of cancer screening is essential to informed decision making about screening. This study’s objectives were to (1) examine people’s beliefs about the accuracy and value of cancer screening, and (2) determine whether sociodemographics, cancer beliefs, and shared decision making are associated with these beliefs.


      Data from the National Cancer Institute’s Health Information National Trends Survey (cycle 4, August–November 2014) were used. Respondents were non-institutionalized adults (aged ≥18 years, n=3,677). Weighted generalized linear modeling was used to examine bivariate and multivariate associations between key covariates and beliefs about cancer screening (assessed by four-item scale and independently). Secondary analyses examined whether these beliefs were associated with self-reported cancer screening. Data were analyzed between 2016 and 2017.


      Only 5.6% (n=189) of respondents answered all four cancer screening items correctly. Men, racial/ethnic minorities, and those with lower education and higher cancer fatalism were less likely to have accurate beliefs about cancer screening. However, those who reported shared decision making for colorectal cancer screening were more likely to know that “when a test finds something abnormal, more tests are needed to know if it is cancer” and “when a test finds something abnormal, it is [not] very likely to be cancer” (adjusted risk ratio=1.13, p<0.01, adjusted risk ratio=1.25, p<0.01). Beliefs were not associated with likelihood of past mammography or Pap testing.


      Educators, researchers, and clinicians should consider opportunities (e.g., through shared decision making) to improve the accuracy of individuals’ beliefs about cancer screening.
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        • Sheridan S.L.
        • Harris R.P.
        • Woolf S.H.
        • Shared Decision-Making Workgroup of the USPSTF
        Shared decision making about screening and chemoprevention. a suggested approach from the U.S. Preventive Services Task Force.
        Am J Prev Med. 2004; 26: 56-66
        • Institute of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        Institute of Medicine, Washington, DC2001
        • Woolf S.H.
        The price of false beliefs: unrealistic expectations as a contributor to the health care crisis.
        Ann Fam Med. 2012; 10: 491-494
        • Hudson B.
        • Zarifeh A.
        • Young L.
        • Wells J.E.
        Patients’ expectations of screening and preventive treatments.
        Ann Fam Med. 2012; 10: 495-502
        • Hoffmann T.C.
        • Del Mar C.
        Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review.
        JAMA Intern Med. 2015; 175: 274-286
        • Hochbaum G.
        • Kegels S.
        • Rosenstock I.
        Health Belief Model.
        U.S. Public Health Service, Washington, DC1952
      1. National Cancer Institute. HINTS Health Information National Trends Survey. Accessed January 1, 2018.

        • Westat
        Health Information National Trends Survey 4 (HINTS 4): Cycle 4 Methodology Report.
        Westat, Rockville, MD2015
        • Finney Rutten L.J.
        • Agunwamba A.A.
        • Beckjord E.
        • Hesse B.W.
        • Moser R.P.
        • Arora N.K.
        The relation between having a usual source of care and ratings of care quality: does patient-centered communication play a role?.
        J Health Commun. 2015; 20: 759-765
      2. National Cancer Institute. HINTS Health Information National Trends Survey. Survey Instruments. Published 2017. Accessed June 28, 2017.

        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • McAlearney A.S.
        • Reeves K.W.
        • Dickinson S.L.
        • et al.
        Racial differences in colorectal cancer screening practices and knowledge within a low-income population.
        Cancer. 2008; 112: 391-398
        • Ford J.S.
        • Coups E.J.
        • Hay J.L.
        Knowledge of colon cancer screening in a national probability sample in the United States.
        J Health Commun. 2006; 11: 19-35
        • James A.S.
        • Daley C.M.
        • Greiner K.A.
        Knowledge and attitudes about colon cancer screening among African Americans.
        Am J Health Behav. 2011; 35: 393-401
        • Sach T.H.
        • Whynes D.K.
        Men and women: beliefs about cancer and about screening.
        BMC Public Health. 2009; 9: 431
        • Laiyemo A.O.
        • Doubeni C.
        • Pinsky P.F.
        • et al.
        Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities.
        J Natl Cancer Inst. 2010; 102: 538-546
        • Nguyen K.H.
        • Pasick R.J.
        • Stewart S.L.
        • Kerlikowske K.
        • Karliner L.S.
        Disparities in abnormal mammogram follow-up time for Asian women compared with non-Hispanic white women and between Asian ethnic groups.
        Cancer. 2017; 123: 3468-3475
        • Gupta S.
        • Sussman D.A.
        • Doubeni C.A.
        • et al.
        Challenges and possible solutions to colorectal cancer screening for the underserved.
        J Natl Cancer Inst. 2014; 106: dju032
        • Jasem J.
        • Fisher C.M.
        • Amini A.
        • et al.
        The 21-gene recurrence score assay for node-positive, early-stage breast cancer and impact of RxPONDER trial on chemotherapy decision-making: have clinicians already decided?.
        J Natl Compr Canc Netw. 2017; 15: 494-503
        • Schroy 3rd, P.C.
        • Emmons K.
        • Peters E.
        • et al.
        The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial.
        Med Decis Making. 2011; 31: 93-107
        • Dolan J.G.
        • Frisina S.
        Randomized controlled trial of a patient decision aid for colorectal cancer screening.
        Med Decis Making. 2002; 22: 125-139
        • Ruffin M.T.
        • Fetters M.D.
        • Jimbo M.
        Preference-based electronic decision aid to promote colorectal cancer screening: results of a randomized controlled trial.
        Prev Med. 2007; 45: 267-273