Picture this – you feel fit and healthy, you go walking every day, you don’t get ill very often and nothing in your body suggests that anything untoward is going on. Then... you receive a phone call saying that there is a signal in your blood that suggests you might have cancer. How does this make you feel? Shocked, confused, worried, frustrated?
I’m talking about what happens when people take part in cancer screening and have a result that means they need further investigation (sometimes referred to as ‘abnormal’ or a ‘positive result’).
Cancer screening is designed to look for signs of cancer or pre-cancer in asymptomatic people and so by its very nature is not for those who have symptoms – it’s for the healthy population not for patients. In fact, most people who take part in screening do so for reassurance or because it is a good thing to do. This means that a test result suggesting you could have cancer, a test result that makes you a ‘patient’, can come with a host of cognitive, emotional and social implications.
In our recent paper we talk about the central role of expectations in how people make sense of what is happening when they receive a cancer screening result that suggests cancer, within the context of a trial.
While we already have evidence about how people feel when they face this scenario for cervical, colorectal, breast or lung cancer - the data comes from our study of men and women had a cancer signal detected as part of a trial exploring a new cancer blood-test. This places the findings in a new realm, one where the test results come - not from an image or a sample of cells, but from the blood. One where, the test does not look at a single part of the body but looks for ‘cancer’ and then predicts where in the body this is. This new test is not yet offered as cancer screening (results will report on the clinical utility of the test itself sometime next year), but our findings shed light on how such results are interpreted by those who experience them.
This is the first publication from our behavioural science sub-study that included surveys and interviews with people who had a ‘cancer signal’ found as part of the NHS-Galleri trial. We interviewed 20 people who went on to have a cancer found and 20 who did not, using Reflexive Thematic Analysis to interpret participant narratives.
So, how would this result make you feel? Shocked? Surprised? Confused that you can have this result when you feel healthy? Or might the test result explain a bodily change that you hadn’t thought about? Fit with your family history or a test you had a few years ago?
In our study, many of the participants felt shocked but in trying to make sense of the result they drew on how this fit with their expectation of cancer as a possibility. This expectation helped them to make sense of the result, impacted how worried they felt and influenced their decisions to talk about the result with friends and family. Expectations also played a role in how those with cancer felt about receiving their diagnosis and how reassured people without cancer felt when they were told that no cancer was found.
What does all this mean? If the future includes a blood test for multiple cancers offered as cancer screening, supporting those with a ‘cancer-signal’ found will be vital. Since expectations of cancer seem central to how people understand and make sense of this result, we can use this to design support, helping people to acknowledge and reflect on their expectations, and if necessary use relevant cognitive approaches (e.g. reframing thoughts, or Acceptance and Commitment Therapy) to help with this.
Marlow LAV, Schmeising-Barnes N, Waller J. The impact of cancer expectations on psychological responses following a cancer signal detected result in asymptomatic multi-cancer detection (MCED) testing. Br J Cancer. 2025 Sep 9. doi: 10.1038/s41416-025-03180-5. Epub ahead of print. PMID: 40926064.
Note: This work was funded and sponsored by GRAIL Bio UK Ltd as a sub-study within the NHS-Galleri trial. We acknowledge that this could be a competing interest. GRAIL funded the costs of the data collection and research staff salaries through a contract with King's College London/Queen Mary University of London. The funder played no role in the design, conduct, analysis or interpretation of the findings but did have the opportunity to review a draft of the manuscript prior to submission.