Uncertain futures: Individual risk and social context in decision-making in cancer screening

Abstract

A core logic of cancer control and prevention, like much in public health, turns on the notion of decision-making under conditions of uncertainty. Population-level data are increasingly used to develop risk profiles, or estimates, that clinicians and the consumer public may use to guide individual decisions about cancer screening. Individual risk perception forms a piece of a larger social economy of decision-making and choice that makes population screening possible. Individual decision-making depends on accessing and interpreting available clinical information, filtered through the lens of personal values and both cognitive and affective behavioral processes. That process is also mediated by changing social roles and interpersonal relationships. This paper begins to elucidate the influence of this "social context" within the complexity of cancer screening. Reflecting on current work in risk and health, I consider how ethnographic narrative methods can enrich this model. Keywordsrisk; risk perception; cancer; uncertainty; screening There has been great consternation about the advent of a risk society in various literatures, some more critical than others but many greatly oversimplifying the processes by which individuals make sense of "risk information" as it is presented to the general public (Forde 1998). Much of science has focused on mechanistic pathways emphasizing cognitive rationality, while under-valuing the contributing dynamics of affect and other non-rational processes. Cancer screenings, and the attendant technologies that make screening possible, represent something new and different in so far as this social practice emerges out of specific medico-scientific techniques (DNA amplification, for example), growing knowledge of the carcinogenic process itself that enable clinical scientists to identify pre-neoplastic lesions earlier, and the interaction of this knowledge and technique with organized social bureaucracies like managed care, cancer registries or national health systems. The process of risk determination itself, however, remains a complex human behavior involving the interaction of a primarily cognitive assessment of component factors with affective and attitudinal mediators that feed into that ordered, rational assessment. We make sense of this new information and prioritize attributions in the context of existing behaviors and social contexts. Thus, independent of access and accuracy of screening modality, the success of cancer screening depends on how people recognize and relate to ideas about the possibility of developing cancer at some point in their future. Those attitudes affect actual screening behaviors (Han, Kobrin et al. 2007). The key conceptual operation behind a strategy of early detection pivots on the successful translation of risk estimation from population to individual. However, while

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Deliberative and intuitive risk perceptions as predictors of colorectal cancer screening over time

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