Defensive Beliefs May Prevent Individuals From Partaking in Screening for Colorectal Cancer

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Investigators have revealed that individuals who react defensively to an invitation for colorectal cancer screening may be less likely to take part, according to a new study published by Clarke et al in Cancer.


Colorectal cancer is one of the most treatable cancer types—especially if detected early—however, many individuals do not undergo recommended screenings, even despite the availability of at-home fecal immunochemical test (FIT) kits.

Study Methods and Results

In the new study, the investigators surveyed individuals in Dublin who had been invited to participate in a FIT-based screening program from 2008 to 2012. Questionnaires were mailed in September 2015 to all individuals who were invited to participate in two screening rounds but had declined, and a random sample of individuals who had agreed to participate in the screenings. Following two reminders, the questionnaires were completed by 1,988 individuals who had participated in the screenings and 311 who had not.

The investigators uncovered that individuals who did not participate in the FIT-based screenings were more likely to provide responses indicating greater defensiveness. This was apparent for all questions related to the four domains of defensive information processing:

  • Attention avoidance (reducing risk awareness by avoidance)
  • Blunting (active mental disengagement through avoidance and denial)
  • Suppression (acknowledging others’ risk but avoiding personal inferences through beliefs of self-exemption)
  • Counterargumentation (arguing against the evidence).


“[Individuals] who react defensively to the invitation to colorectal cancer screenings are less likely to take part, and this seems to be due to such misconceptions that having a healthy lifestyle or having regular bowel movements means that they do not need to be screened. Similarly, some [individuals] believe testing can be delayed while they wait for a ‘better’ test (even though the current test works very well) or wait until their other health concerns are under control,” explained Nicholas Clarke, PhD, a postdoctoral researcher at the Dublin City University School of Psychology. “Some [individuals] also react defensively because they believe cancer is always fatal, which is not true. All of these factors can result in [individuals] making a decision not to take the [FIT]-based screening test,” he underscored.

Dr. Clarke and his colleagues noted that the study’s findings indicated that even well-designed health communication campaigns and proactive screening programs may be hindered by individuals’ defensive beliefs.

“The measures used in this study could be used to help identify [individuals] who may need extra support to take part in colorectal cancer screening programs worldwide,” Dr. Clarke highlighted, concluding that “The results suggest that screening programs need strategies to decrease procrastination and address misconceptions about colorectal cancer and screening.”

Additionally, the investigators stressed the importance of trying to make colorectal cancer screenings widely adopted by every individual who reaches middle age.

An accompanying editorial published in Cancer by Beverly Beth Green MD, MPH, Professor of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine and a senior investigator at Kaiser Permanente Washington Health Research Institute, advocated for additional research to test different strategies—such as financial incentives—for decreasing defensive information processing.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.