Prevalence and Correlates of Worry About Medical Imaging Radiation
Among United States Cancer Survivors
Jennifer L. Hay
Raymond E. Baser
Joy S. Westerman
Jennifer S. Ford
International Society of Behavioral Medicine 2018
Purpose Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of
these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for
survivors. The aims of this paper are to describe cancer survivors’ level of worry about medical imaging radiation (MIR) and to
identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust.
Method This cross-sectional study used the 2012–2013 Health Information National Trends Survey of US adults conducted by
the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic
regression analysis was used to evaluate factors associated with higher MIR worry (reporting Bsome^ or Balot^ of MIR worry).
Results Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions
indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who
completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in
Conclusion Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns
of worry could aid efforts to improve these individuals’ survivorship care and education.
Over the past few decades, the number of individuals who have
been diagnosed with cancer in the USA has steadily increased.
In 2016, 15.5 million living Americans had a history of cancer
. These cancer survivors generally undergo repeated diag-
nostic medical imaging to screen for new and/or recurrent can-
cer . These enhanced surveillance regimens can help address
survivors’ worries about developing new primary as well as
recurrent disease. Such worries are quite prevalent, with up to
60% of survivors reporting moderate to severe worry about
recurrence 1 year after diagnosis . Worries may be intense
prior to scheduled scans, such as screening mammography,
given that the tests may show recurrent or new disease [4, 5].
Yet cancer worry may persist long after treatment ends ,
leading to distress and reduced quality of life [3, 7–9].
Predictors of cancer worry in the survivorship context include
depression, lower quality of life, being female, younger age,
and having more intensive treatment regimens, as well as the
presence and severity of physical symptoms [3, 10–12].
There are multiple, diverse theoretical perspectives on how
worry about cancer might relate to important protective be-
haviors such as cancer screening and surveillance [13, 14]. For
instance, worry has been proposed to facilitate screening
[15–18] in Leventhal’s Common Sense Model [15, 16, 18],
also called the dual process or parallel response model .
This model proposes that cognitive representations of disease
drive the development of an action plan for coping with the
threat of disease, as well as a parallel plan for coping with
emotional reactions to this threat (such as cancer worry).
Similarly, the Health Belief Model  has been used to jus-
tify cancer worry as a facilitator of screening as an aspect of
susceptibility or severity beliefs, with measures of cancer
* Jennifer L. Hay
Department of Psychiatry and Behavioral Sciences, Memorial Sloan
Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New
York, NY 10022, USA
Department of Epidemiology and Biostatistics, Memorial Sloan
Kettering Cancer Center, New York, NY, USA
International Journal of Behavioral Medicine