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Dominant health care professional discourses on cancer take for granted high levels of individual responsibility in cancer prevention, especially in expectations about preventive screening. At the same time, adhering to screening guidelines can be difficult for lower-income and under-insured individuals. Colorectal cancer (CRC) is a prime example. Since the advent of CRC screening, disparities in CRC mortality have widened along lines of income, insurance, and race in the United States. We used a community-engaged research method, Photovoice, to examine how people from medically-underserved areas experienced and gave meaning to CRC screening. In our analysis, we first discuss ways in which participants recounted screening as a struggle. Second, we highlight a category that participants suggested was key to successful screening: social connections. Finally, we identify screening as an emotionally-laden process that is underpinned by feelings of uncertainty, guilt, fear, and relief. We discuss the importance of these findings to research and practice.

In this paper, we analyze narratives from a Photovoice project on colorectal cancer screening that was carried out with people who had undergone screening and were found to not have cancer. Three groups, totaling eighteen participants, took part in the project, meeting multiple times over the course of approximately 10 weeks, and discussing photos they took about colorectal cancer screening. A common way in which the participants conveyed their screening experiences was through reflection on their own or other people's illnesses. Our findings highlight the multiple meanings of receiving a 'good' or noncancerous screening result after undergoing cancer screening. Such findings suggest that framing noncancerous results only in terms of relief or other positive emotions may ignore the realities people and their families face and their remaining concerns. This paper has broader implications for policies to reduce cancer disparities as well as public health and patient-provider communication about screening. [Colorectal < Cancer Type; Qualitative < Research Methods; Photovoice; Narrative research; Health care disparities] Colorectal cancer (CRC) screening, particularly through colonoscopy, is highly effective in reducing mortality. 1 A CRC diagnosis now has a promising 5-year survival rate of 90 percent when it is detected early, and polyps can be removed prior to becoming malignant. However, only 39 percent of people diagnosed with CRC are diagnosed at this early stage, when the cancer remains localized, 2 and there are substantial disparities in CRC incidence and mortality along lines of socioeconomic status, race and ethnicity, and in medically under-served geographic areas. 3 Because differences in CRC screening uptake contribute to CRC disparities, 4 barriers to CRC screening have been a prime area of study for health researchers. 5-9 To better understand screening uptake, we carried out a community-based participatory research project on CRC screening with people from medically-underserved areas to hear their screening narratives. We focus on narratives because narratives are integral to how people "make sense of" 10 and "work through their experiences." 11 Narratives of health or illness offer insight into "local moral worlds," in the neighborhoods, families, and communities in which people carry out

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