Cancer stigma and cancer screening attendance: a population based survey in England

Cancer-related stigma attracts considerable research interest, but few studies have examined stigmatisation in the healthy population. Qualitative studies suggest that stigma can discourage people from attending cancer screening. We aimed to quantify the prevalence and socio-demographic patterning of cancer stigma in the general population and to explore its association with cancer screening attendance.

In 2016, 1916 adults aged 18-70 years took part in home-based interviews in England. Measures assessed demographic characteristics, self-reported screening uptake for cervical (n = 681), breast (n = 326) and colorectal cancer (n = 371), and cancer stigma. Cancer stigma was measured with the validated Cancer Stigma Scale which assesses six subdomains (Severity, Personal Responsibility, Awkwardness, Avoidance, Policy Opposition, and Financial Discrimination), from which a mean score was calculated. Logistic regression analyses examined the association between cancer stigma and having been screened as recommended versus not.

Levels of cancer stigma were low, but varied across the six subdomains. Items regarding the severity of a cancer diagnosis attracted the highest levels of agreement (30-51%), followed by statements about the acceptability of making financial decisions on the basis of a cancer diagnosis such as allowing banks to refuse a mortgage (16-31%) and policy opposition statements such as not having a responsibility to provide the best possible care for cancer patients (10-17%). A similar proportion anticipated feeling awkward around someone with cancer (10-17%). Only 8-11% agreed with personal responsibility statements, such as that a person with cancer is to blame for their condition, while 4-5% of adults anticipated avoiding someone with cancer. Stigma was significantly higher in men (p < .05) and in those from ethnic minority backgrounds (p < .001). Higher cancer stigma was associated with not being screened as recommended for all three screening programmes (cervical: adjusted OR 1.59, 95% CI 1.15-2.20; breast: adjusted OR = 1.97, 95% CI 1.17-3.32; colorectal: adjusted OR = 1.59, 95% CI 1.06-2.38).

Cancer stigma is generally low, but some aspects of stigma are more prevalent than others. Stigma is more prevalent in certain population subgroups and is negatively associated with cancer screening uptake. These benchmark findings may help track and reduce cancer stigma over time.