Cancer is recognized as the second leading cause of death in the United States (U.S.) . It is projected that approximately 1.9 million new cancer diagnoses and 608,570 related deaths will occur in 2021 in the U.S. . Additionally, nearly 1 in 3 Americans will be diagnosed with cancer at some point in their lifetime . The prevalence of cancer in the U.S. has been increasing in the past few years due to reasons such as improvements in cancer treatment, population growth, increasing screening rates, and increasing life expectancy . The rising cancer burden has contributed to an increase in the national cancer-related expenditure over the years. The estimated national expenditure for cancer care in the U.S. was $201 billion in 2020, up from $183 billion in 2015 . This figure is projected to increase to 246 billion by 2030 (34% increase from 2015) . The increasing cancer and associated financial burden have not only impacted the physical and mental health of diagnosed people but also their families, communities, and society as a whole; making cancer a major public health concern .
Several factors affect an individual’s risk of morbidity and mortality from cancer. These include socioeconomic status (SES), race, gender, and lifestyle. Low SES, African American race, anxiety/depression, male gender, and smoking have been associated with increased morbidity and mortality from cancer [2, 7, 8]. On the other hand, behavioral factors such as healthy eating, screening uptake, vaccinations have been shown to reduce cancer risk . Modifiable behavioral risk factors such as alcohol use, lack of physical activity, smoking, and diet are thought to account for approximately a third of cancer deaths [9, 10]. Adoption and/or maintenance of these risk factors as well as other risk promoting behaviors could increase cancer risk while the converse is true [9, 10].
Factors that predict adoption of cancer risk modifying behaviors are not fully understood. Cancer fatalism, the belief or perception that developing cancer is out of one’s control, that cancer is not preventable for individuals who ‘must’ have it, or that a cancer diagnosis inevitably leads to death [11–13], has been shown to be inversely associated with adoption of risk reducing behaviors such as participation in cancer prevention screening programs  and positively correlated with late symptomatic presentation [15, 16]. Studies examining this subject show that racial minorities tend to hold more fatalistic views of cancer and to be less knowledgeable about cancer risk factors compared with their non-Hispanic White counterparts [14, 17]. Although these findings were shown to persist among Latinas with high levels of acculturation , it is unclear if any within race differences exist. Additionally, the role of mental health on these beliefs has yet to be explored.
Perceived cancer communication ambiguity, another concept thought to affect likelihood of involvement in cancer risk modifying behaviors, is defined as “uncertainty regarding the trustworthiness, reliability or adequacy of information pertaining to cancer prevention” . Previous studies using the 2003 and 2005 Health Information National Trends Survey (HINTS) surveys found that perceived cancer communication ambiguity was not only associated with a decreased perception of cancer preventability but also with a decreased tendency to perform risk reducing behaviors [18, 19]. The mechanism by which it occurs is believed to be ambiguity aversion, which is the tendency to be pessimistic in decision making in the presence of ambiguity/uncertainty . Much of the ambiguity is thought to stem from the multiplicity of information reaching the public. There have been suggestions that the abundance of information, rather than empowering the public, could achieve the unintended opposite effect . Although much emphasis has been placed on the impact of ambiguity on cognitive processes, its predictors remain less widely explored. A study of predictors of ambiguity using 2005 HINTS survey data found that age, race, education, and mass media exposures were associated with perception of ambiguity . This study, however, did not examine the possible role of mental health, which is known to affect cognitive processing. Current thinking posits that depression is characterized by an excessive amplification of and difficulty disengaging from negative information . Since this study was performed, there has been a proliferation in the number of information sources . It is unclear how this has affected the prevalence of perceived ambiguity and/or how the effect of sociodemographic characteristics has evolved over the years.
Our study aims at exploring the impact of anxiety/depression on cancer fatalism and ambiguity regarding cancer prevention recommendations. Additionally, we will assess within-anxiety/depression status and within-race differences in these negative perceptions. An improved understanding of these associations could help health care providers and health educators to target their interventions more effectively.