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Cancer fear and the interpretation of ambiguous information related to

cancer
Anne Miles a; Sanne Voorwinden a; Andrew Mathews b; Laura C. Hoppitt c; Jane Wardle a
a
University College London, London, UK b University of California, Davis, CA, USA c University of
East Anglia, Norwich, UK
First published on: 19 May 2008
To cite this Article Miles, Anne, Voorwinden, Sanne, Mathews, Andrew, Hoppitt, Laura C. and Wardle, Jane(2009) 'Cancer
fear and the interpretation of ambiguous information related to cancer', Cognition & Emotion, 23: 4, 701 — 713, First
published on: 19 May 2008 (iFirst)
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COGNITION AND EMOTION
2009, 23 (4), 701713
Cancer fear and the interpretation of ambiguous

information related to cancer
Anne Miles and Sanne Voorwinden
University College London, London, UK
Andrew Mathews
University of California, Davis, CA, USA
Downloaded By: [B-on Consortium - 2007] At: 14:40 10 December 2009
Laura C. Hoppitt
University of East Anglia, Norwich, UK
Jane Wardle
University College London, London, UK
We tested the hypothesis that people with a high fear of cancer would be more likely
to interpret ambiguous information about cancer in a negative manner compared
with people low on cancer fear. Adults (n47) aged 5070, who scored either high
(n16) or low (n31) on cancer fear, took part in a laboratory-based ambiguous
sentences task. Participants were presented with ambiguous cancer and social threat
scenarios mixed with unambiguous neutral scenarios. Interpretations were assessed
in a recognition task, by asking participants to rate disambiguated sentences in
terms of how similar in meaning they were to the originals. People high on cancer
fear were more likely to endorse negative interpretations of the original ambiguous
cancer scenarios than were people low on cancer fear. This negative interpretation
bias was specific to cancer scenarios and was not observed for the social threat
scenarios.
Correspondence should be addressed to: Anne Miles, Department of Epidemiology and

Public Health, University College London, Gower Street, London WC1E 6BT, UK. E-mail:
a.miles@ucl.ac.uk
We would like to thank Cancer Research UK who funded this study (Grant code C8668/
A5764); the work was undertaken with the support of Camden and Islington Primary Care
Trusts who received a proportion of funding from the NHS Executive. The views expressed in
this publication are those of the authors and not necessarily those of the NHS Executive. There
are no conflicts of interest.
Thanks are also due to the James Wigg GP Practice, The Elizabeth Avenue Group Practice
and the Keats Group Practice, who allowed us to contact their patients and invite them to
participate in this research; and to Bundy Macintosh who provided the social threat scenarios.
# 2008 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
www.psypress.com/cogemotion DOI: 10.1080/02699930802091116
702 MILES ET AL.
INTRODUCTION
Cancer is the second biggest cause of premature death in the Western world
but recent estimates suggest that at least half of all cancers could be
prevented through lifestyle changes and adherence to certain types of cancer
screening (such as cervical screening, which aims to detect and treat
pre-malignant lesions; e.g., Colditz, Sellers, & Trapido, 2006). Accordingly,
strategies for cancer control have increasingly focused on encouraging
people to try and reduce their cancer risk through behaviour change.
An important first step in persuading people to alter their behaviour is to
get them to engage with cancer control information, and research has begun
to explore patterns of cancer information seeking among the general
population (e.g., Nelson et al., 2004). But to be successful, cancer
communication must do more than reach its target audience, it must also
be adequately processed (i.e., be understood and interpreted appropriately).
One group for whom cancer control messages are particularly important
is people high on cancer fear. Cancer fear has been associated with poorer
adherence to screening recommendations (Subramanian, Klosterman,
Amonkar, & Hunt, 2004; Wardle, McCaffery, Nadel, & Atkin, 2004;
although see Hay, McCaul, & Magnan, 2006) and delay in seeking help
for suspicious symptoms (e.g., Macdonald, Macleod, Campbell, Weller, &
Mitchell, 2006). One possible explanation for this is that fear impedes cancer
information processing: cancer fear could result in the poorer processing of
information, leading to lower levels of awareness that screening and early
diagnosis can reduce cancer incidence and mortality. Equally, cancer fear
could be linked with the negative interpretation of cancer information,
leading to greater pessimism about the potential to control cancer via
prevention and early detection, and hence lower uptake of cancer control
behaviours.
Of particular interest in the context of cancer communication is the way
people interpret ambiguous information. Information about the potential
for cancer control via health behaviours has the potential to be ambiguous
on at least one of two levels. The meaning of a particular sentence may be
unclear and could have more than one interpretation. Or there may be two
or more statements about a topic that contradict each other. Han and
colleagues examined the latter situation and found that perceived ambiguity
concerning cancer screening recommendations was associated with increased
perceived cancer risk and cancer worry, and decreased perceptions of cancer
preventability (Han, Moser, & Klein, 2006). This study examined psycho-
logical correlates of the perceived presence of conflicting but unambiguous
statements, rather than the presence of ambiguity or unclear meaning per se.
Nevertheless, it suggests that responses to ambiguous cancer information
may be associated with cancer fear, and that this issue would benefit from
CANCER FEAR AND INTERPRETATION 703
further exploration within a more experimentally controlled approach, using

paradigms that directly assess the interpretational process.
Previous experimental research in the area of cognition and emotion has
shown that an individual’s mood state can affect the way they interpret
ambiguous material. While it has been shown that mood states such as
disgust (Davey, Bickerstaffe, & MacDonald, 2006) and anger (Wenzel &
Lystad, 2005) are associated with a negative interpretation bias, most
research on this topic has been concerned with anxiety. Given the conceptual
similarity between fear and anxiety, comparable results might be expected
for fear as have been demonstrated in anxiety.
Interpretative biases in anxiety have been demonstrated using both
auditorily presented homophones (words that sound the same but are
different in meaning, e.g., dye/die; e.g., Mathews, Richards, & Eysenck,

1989) and ambiguous sentences (Eysenck, Mogg, May, Richards, &
Mathews, 1991). For example, Eysenck et al. (1991) found that participants
with generalised anxiety disorder were more likely than recovered anxious
participants or controls to select the threatening rather than the non-
threatening interpretations of the ambiguous sentences, although this bias
did not appear to be specific to people’s particular concerns (physical or
social threat). Similarly, people high on hypochondriasis showed a general
bias towards making threatening interpretations following the presentation
of ambiguous social and illness threat scenarios, rather than one specific to
illness alone (Hitchcock & Mathews, 1992). Other studies, though, have
noted a specificity effect (e.g., Calvo & Castillo 1997; Huppert, Foa, Furr,
Filip, & Mathews, 2003). Using the ambiguous sentences task, Huppert et al.
observed a significant correlation between social anxiety and the negative
interpretation of scenarios but only for social and not for other scenarios
with non-social content (Huppert et al., 2003).
The present study aimed to test the hypothesis that high cancer fear
would be associated with a greater tendency to interpret scenarios in a
negative way compared with low cancer fear, and that this effect would be
specific to cancer rather than social threat scenarios.
METHOD
Ethical approval for the study was granted by Camden and Islington
Community Local Research Ethics Committee.
Design
Participants with high or low fear of cancer read a series of ambiguous
scenarios related to cancer or social situations, intermixed with neutral filler
items. They were then required to rate a series of sentences in terms of how
704 MILES ET AL.
similar they were in meaning to the original scenarios. These sentences

disambiguated the original scenarios in either a positive or a negative
direction. The latter ‘‘target’’ items were intermixed with ‘‘foils’’ that also
had positive or negative meanings, but were not possible interpretations of
the original scenarios. The dependent variable was the rated similarity score
for each type of item (see materials section). There was therefore one
between-group variable: Cancer Fear (high, low), and three within-subjects
variables: Scenario Type (cancer, social), Statement Type (target, foil) and
Valence (positive, negative).
Participants
Forty-seven people were drawn from a larger group of volunteers who were
aged 5070 and registered at one of three GP practices in London. They
were selected on the basis of high (]25; n16) or low (519; n31) levels
of self-reported cancer fear following completion of a postal survey, after
excluding those with a previous cancer diagnosis or elevated depression
(a CES-D score of 13 or over, see below). The high and low cut-offs for the
cancer fear scale comprised the upper and lower tertiles observed in the
original sample of volunteers who completed the survey.
There were no significant differences between the high and low cancer
fear groups in terms of age, gender, verbal IQ, social anxiety or depression.
However, the high cancer fear groups had higher levels of state anxiety than
the low cancer fear group, t(45)2.31, p.026, partial h2 .11 (see Table 1).
Materials
Ambiguous scenarios. Thirty-five scenarios were included, each being a
few sentences in length. Of these, 10 were related to cancer, 10 were social
and 15 were neutral fillers (used to make the purpose of the experiment less
TABLE 1
Means (and SDs) for demographic and psychological
differences between high and low cancer fear groups
Low fear (n31) High fear (n16)
Age 61.26 (4.92) 60.46 (5.79)

% female 60.0 62.5
Verbal IQ 55.39 (4.29) 56.06 (3.37)
Cancer fear 14.82 (3.21) 28.56 (2.96)
State anxiety 9.10 (2.53) 11.30 (3.99)
Social anxiety 9.39 (7.77) 11.69 (7.79)
Depression 8.93 (3.70) 10.60 (4.30)
obvious). The 10 social scenarios had been used in previous research

(Mathews & Mackintosh, 2000). The cancer and neutral scenarios were
developed for the present study. Cancer scenarios were designed to include
material about the potential for cancer cure and prevention, as well as
symptom interpretation. Both the cancer and social scenarios were designed
to be ambiguous.
Scenarios ended with a word fragment that participants were required to
complete, and they were also followed by a comprehension question. Both of
these tasks were added to ensure that participants had read and understood
the non-ambiguous parts of each situation. An example of an ambiguous
scenario is given below along with the four sentences that participants were
given to rate to assess their interpretation of the original.
You go to meet your surgeon to discuss surgical options for your cancerous tumour.
Your surgeon says he can tell instantly from the position of your tumour whether
surgery is p_ssible.
In this instance, the word to complete was ‘‘possible’’ and the question
participants were asked was:
Did your surgeon discuss chemotherapy with you?
Participants were given immediate feedback as to whether they had answered

correctly or not.
Test sentences. Four disambiguated sentences were developed for each

original scenario. Two of these (one positive and one negative) were designed
to be possible interpretations of the original (targets), while the other two
(again one positive and one negative) were designed to be unrelated to the
meaning of the original (foils). Examples of the four sentences for the
scenario shown above are:
Negative cancer target: Your surgeon can tell instantly from the position of your
tumour that surgery is impossible.
Positive cancer target: Your surgeon can tell instantly from the position of your
tumour that surgery is possible.
Negative cancer foil: Your surgeon can tell instantly from the position of your
tumour that surgery will be painful.
Positive cancer foil: Your surgeon can tell instantly from the position of your tumour
that surgery will be quick.
These four sentences were presented in random order, in a block, and

participants were asked for ratings of similarity to the original on a 4-point
scale where 1very different in meaning, 2different in meaning, 3similar
in meaning, and 4very similar in meaning.
706 MILES ET AL.
Validity ratings. To check the content validity of the scenarios, eight

individuals, who were not in the study, rated the 35 original cancer, social
and neutral scenarios and their disambiguated sentences on several
attributes on a scale of 17: similarity, ambiguity, related to cancer, related
to social threat, positivity and negativity.
As intended, targets were rated as more similar to the original statements
than the foils, F(1, 7)9.17, p.03, partial h2 .57, and this difference
was the same across the three scenario types, F(2, 14)B1, partial h2 .02;
both the cancer and social scenarios were rated as more ambiguous than
the neutral ones, F(1, 7)25.32, p.002, partial h2 .78; F(1, 7)27.47,
pB.001, partial h2 .80, respectively, and there was no difference in
ambiguity between the original cancer and original social statements,
F(1, 7)1.07, ns, partial h2 .13. The cancer scenarios were rated as
more cancer related than the social scenarios, F(1, 7)688.03, pB.001,
partial h2 .99, and while both the social and cancer scenarios were rated
as more related to social threat than the neutral scenarios, F(1, 7)42.57,
pB.001, partial h2 .86; F(1, 7)7.48, p.029, partial h2 .52, respec-
tively, there was no difference between the cancer and social scenarios,
F(1, 7)3.17, ns, partial h2 .31. Hence the cancer and social scenarios
differed in terms of cancer relatedness but were broadly matched for social
threat. The positive statements (targets and foils) were rated as significantly
more positive than the negative targets and foils (means 4.88 vs. 1.75),
F(1, 7)301.34, p B.001, partial h2 .98, and the negative statements were
rated as significantly more negative than the positive targets and foils (means
2.05 vs. 5.15), F(1, 7)507.86, p B.001, partial h2 .99.
Questionnaires
Participant sex and age were supplied by the GP practices. Cancer fear was
assessed in the postal survey. Depression, state anxiety, social anxiety and
verbal IQ were assessed after completion of the ambiguous sentences task.
Cancer fear. This was assessed using the 8-item measure developed by
Champion et al. (2004). After the question: ‘‘How do you feel when you
think about cancer?’’ were eight items, e.g., ‘‘The thought of cancer scares
me’’. For each item, the response options were: strongly disagree, disagree,
not sure, agree, strongly agree.
Depression. This was measured using the 10-item version of the Center
for Epidemiological Studies Depression scale (CES-D; Irwin, Artin, &
Oxman, 1999) asking people about their mood over the last three months.
We used the ‘‘Yale’’ response categories (4-item response scale rarely or none
of the time, a little of the time, a moderate amount of time, most of the time).
A cut-off of more than 25 on the full 20-item scale has been cited as
potentially indicating the presence of major depressive disorder (Haringsma,
Engels, Beekman, & Spinhoven, 2004), suggesting a pro-rata cut-off of 1213
for the shortened scale.
State anxiety. The short-form, 6-item version of the state scale of the
STAI was used (Marteau & Bekker, 1992). The state anxiety instructions
issued after completing the cognitive tasks were to report how participants
had felt during the interpretation task itself rather than right now.
Social anxiety. The Fear of Negative Evaluation Scale (FNE; Watson &
Friend, 1969) was used to measure social anxiety with items such as:
‘‘I rarely worry about seeming foolish to others’’ (true; false).
Verbal IQ. Verbal IQ was assessed with the Spot-the-Word Test, a

measure of crystallised verbal intelligence of the Speed and Capacity of
Language-Processing Test (SCOLP) in which participants tick the item in
each word pair that they think is the real word (broxic oasis; Baddeley,
Emslie, & Nimmo-Smith, 1993).
Apparatus
E-prime version 1.0 software (Psychological Software Tools, Inc., Pitts-
burgh, PA) was used to record participant responses. The task was presented
on a Dell Optiplex GX1 computer.
Procedure
After giving written consent, participants were seated in front of the
computer and given the following instructions:
You are about to see a list of sentences. Try to imagine yourself in each situation as it
is described. Try not to memorise the sentences, but try to understand their meaning
because you will be asked questions about them later.
First, participants read through two neutral practice scenarios followed by a

mixture of cancer, social and neutral scenarios at a self-paced rate. All
scenarios consisted of a title and three lines of text with a word fragment in
the final sentence that was missing 12 letters, to be completed by
participants. They were given a maximum of 30 seconds to read the scenario
and 10 seconds to fill in the first missing letter. Once a letter had been typed,
the correct word was shown and a beep sounded if an incorrect letter had
been entered. Then a comprehension question about the scenario appeared,
to which participants had to answer either ‘‘yes’’ (right arrow) or ‘‘no’’ (left
708 MILES ET AL.
arrow) within 8 seconds. Participants were given direct feedback on their

responses to the comprehension question with a ‘‘correct’’ or ‘‘incorrect’’
message and a beep sound accompanied the latter.
The scenarios were presented in a fixed pseudo-random order, with four
neutral scenarios at the beginning and one at the end to control for primacy
and recency effects. The remaining 30 scenarios (10 of each type) were
presented in the body of the task and only responses to these items were
analysed. The order of presentation of these scenarios was pre-randomised
in groups of three (1 cancer, 1 social and 1 neutral scenario) so that
participants did not encounter more than 2 scenarios of the same type
consecutively. Once determined, the order of presentation of scenarios was
fixed, and hence was the same across participants.
After all the scenarios had been presented, participants were shown four
sentences (2 targets and 2 foils) and were asked to rate each one in terms of
how similar they were to the original scenario. At this point they were
presented with the following instructions:
Please look at these sentences and rate how similar in meaning they are to one of the
descriptions you saw earlier. None of these sentences is worded identically to any
that you have seen but any number of them (1, 2, 3 or all 4) could be related to the
description you saw earlier. Please rate each sentence, independently from all the
others, for its similarity in meaning to the original that you have already seen.
When the procedure was clear to participants the experimenter left the room
and returned after the participant had finished the computer task with the
post-test questionnaire. The session took between 46 and 60 minutes to
complete in total, after which participants were paid and thanked for their
participation.
RESULTS
Signal detection analysis
Signal detection analysis was used to analyse the similarity ratings. This
method offers a way of calculating how good people are at detecting a
similar item (discrimination), while taking account of individual differences
in ‘‘decisional style’’, due to variations in willingness to endorse or reject
items.
Hit rates (for the target sentences) and false alarm rates (for the foil
sentences) were calculated for each sentence type by converting the similarity
ratings (14) into scores ranging from 0 to 1. The ability to discriminate
between the targets and foils is a function of both the hit rate and the false
alarm rate. A high hit rate accompanied by a high false alarm rate reflects
poor ability to discriminate between related and non-related items. Response

bias, on the other hand, is simply a function of the number of false alarms.
Following Eysenck et al. (1991) we used a non-parametric measure. A?
was used, because this measure of discrimination is appropriate when there
are hit or false alarm rates of 1 or 0, which was the case in the present study.
A? scores of 0.5 indicates performance at chance levels. The corresponding
measure of response bias used was BƒD. Values greater than 0 indicate a
conservative bias, values less than 0 a liberal bias, and 0 represents neutrality.
One (low fear) participant had to be excluded because their false alarm rate
exceeded their hit rate for one of the conditions making their discrimination
score unreliable. This left 46 as the sample for analysis.
The discrimination scores were analysed using a three-way mixed
ANOVA, with Scenario Type (cancer, social) and Valence (positive, negative)
as within-subjects variables, and Cancer Fear (high, low) as the between-
subjects variable. Means and standard deviations of participant A? scores are
shown in Table 2 along with similarity ratings.
The main hypothesis was that people high on cancer fear would interpret
the cancer scenarios more negatively than people low on cancer fear and that
no such group differences would be observed for the social threat scenarios.
Consistent with this, there was a significant interaction between cancer fear,
valence and scenario type, F(1, 44)4.81, p.034, partial h2 .10. This
interaction remained significant after controlling for both state anxiety
(because this was higher in the high-fear group) and verbal IQ in an analysis
of covariance, F(1, 42)6.41, p.015, partial h2 .14.
TABLE 2
Discriminability values and similarity scores by cancer fear,
scenario type and valence (means and SDs)
Low fear (n30) High fear (n16)
Discriminability values
Cancer negative 0.72 (0.11) 0.79 (0.06)
Cancer positive 0.63 (0.07) 0.63 (0.07)
Social negative 0.76 (0.08) 0.76 (0.07)
Social positive 0.78 (0.07) 0.81 (0.05)
Similarity scores
Cancer negative target 1.88 (0.50) 2.10 (0.49)
Cancer positive target 2.13 (0.46) 1.88 (0.38)
Social negative target 2.11 (0.48) 2.22 (0.53)
Social positive target 2.87 (0.38) 2.59 (0.51)
Cancer negative foil 1.27 (0.30) 1.19 (0.16)
Cancer positive foil 1.72 (0.36) 1.56 (0.32)
Social negative foil 1.31 (0.27) 1.36 (0.32)
Social positive foil 1.73 (0.39) 1.41 (0.33)
710 MILES ET AL.
To clarify this three-way interaction, it was decomposed by valence with

negative and positive recognition sentences examined separately. Analysis of
negative sentences alone revealed an interaction between group and scenario
type, F(1, 44)4.23, p.046, partial h2 .09. In the equivalent analysis of
the positive scenarios, the same interaction was not significant, F(1, 44)
1.75, ns, partial h2 .04, suggesting that significant group differences were
confined to negative interpretations. Finally, decomposing the two-way
interaction for negative scenarios by group showed that discrimination
scores for negative cancer sentences were greater in high- than low-fear
participants, t(1, 44)2.46, p.018, partial h2 .12. The same contrast was
not significant for social scenarios (tB1, partial h2 .00). These results
show that high-fear participants were more likely to rate the negative cancer
statements as similar to the ambiguous originals relative to the low-fear

group. No such pattern was observed for the negative social threat
statements.
Analysis of response bias scores failed to reveal a significant three-way
interaction between group, scenario type and valence, F(1, 44)2.44, ns,
partial h2 .05. Furthermore, even when analysed separately by valence, the
two-way interaction of group by scenario type failed to reach significance
either for negative, F(1, 44)1.57, ns, partial h2 .03, or positive scenarios,
F(1, 44)1.44, ns, partial h2 .03. In sum, high cancer fear participants
were more sensitive to negative interpretations of ambiguous cancer
scenarios than were low-fear participants. This effect was not accompanied
by a corresponding response bias effect, and was absent for social scenarios.
DISCUSSION
People high on cancer fear were more likely to make negative interpretations
of ambiguous information when that information was related to cancer,
but not when it was related to possible social threats. These findings are
similar to those sometimes observed in the anxiety literature where concern-
specific interpretation biases have been found (e.g., Calvo, Avero, Castillo, &
Miguel-Tobal, 2003).
The finding of higher endorsement of negative interpretations of the
cancer scenarios in the high-fear compared with the low-fear group was not
accompanied by the converse effect for positive interpretations, suggesting
the presence of a negative interpretative bias rather than the lack of a
positive bias. In the social anxiety literature it has been argued that tasks
assessing ‘‘on-line’’ interpretations (measured as they occur, using objective
methods) tend to show a lack of positive bias, whereas ‘‘off-line’’ tasks
(where interpretations are assessed retrospectively by self-report) tend to
show negative biases (Huppert et al., 2003). The present task produced
results apparently more consistent with the latter findings, although we do

not know whether the ambiguous cancer-related material used here was
equally sensitive to positive and negative interpretations, so our results may
reflect limitations in the materials used. A further limitation of the study was
the relatively small sample size, and unequal numbers in the high- and low-
fear groups, both of which may have weakened the power of the study.
The inclusion of foils in the present study allowed assessment of response
bias effects: none were observed, a result that argues strongly against generic
endorsement of any negative statements as an adequate explanation for the
present results. However, the high cancer fear group also reported higher
levels of state anxiety, raising the possibility that differences in mood state
(rather than fear of cancer) may have caused the apparent interpretation bias
observed here. This explanation seems unlikely to provide a complete

explanation as controlling for state anxiety in an analysis of covariance did
not alter the pattern of results, although a stronger test would have been to
match cancer fear groups in terms of anxiety level. Also, it remains possible
that the observed bias was a joint product of cancer fear and current mood
state; for example, it could be negative interpretative bias in high-fear
individuals is enhanced by the presence of a negative mood state. A final
alternative possibility is that people with high levels of cancer fear were more
likely to generate negative images in response to the cancer scenarios,
facilitating access to negative interpretations and leading to the negative
interpretative bias observed here (see Hirsch, Clark, & Mathews 2006).
While the causal nature of the relationship between interpretation biases
and fear cannot be established from the current study, the results are
consistent with the possibility that fear of cancer may be maintained, in part
at least, by the tendency to assume the worst when presented with
ambiguous cancer information, reinforcing feelings of fear about the disease.
Further research would be needed to assess whether such an interpretation
bias helps maintain cancer fear by testing the effect of interpretation
‘‘retraining’’ on reducing it (e.g., Mathews & MacLeod, 2002).
In addition to explaining why cancer fear may be maintained, there is also
a possibility that negative interpretation biases may explain the link between
cancer fear and other cancer-related beliefs. Cancer fear is usually associated
with higher perceived personal risk of getting cancer, higher perceived cancer
severity and higher beliefs that cancer cannot be controlled. It is plausible
that these associations may be mediated by the tendency to interpret
ambiguous information in a negative way, resulting in more negative views
about the likelihood of developing cancer, its severity and the (limited)
potential to prevent or cure the disease. Further research could usefully
explore the relationship between fear, the interpretation of ambiguous
sentences and how these both relate to other cancer-related beliefs.
712 MILES ET AL.
Because the task used in the present study assessed interpretation biases
retrospectively, rather than at the instant the sentence was read, the
contribution of a negative recall bias rather than a true negative interpreta-
tion bias cannot be ruled out. Although exploration of this issue by using
different tasks could help reveal the exact mechanism at work, the finding
reported in the present study suggests that it may be important to reduce any
ambiguity in cancer communications whatever the mechanism concerned
turns out to be. Certainly it seems that ambiguity in cancer communication
may lead to negative interpretations in people who are already fearful of
cancer. This may help reinforce their feelings of fear about the disease and
promote the view that cancer cannot be prevented or cured. Future work
needs to examine whether cancer communication can reduce the potential
for negative inferences to be drawn from cancer information in order to

reduce fear but also to reduce fatalistic beliefs, which can also act as a
significant deterrent to the adoption of cancer control behaviours.
Manuscript received 12 December 2007

Revised manuscript received 8 February 2008
Manuscript accepted 28 March 2008
First published online 19 May 2008
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On: 10 December 2009

Cognition & Emotion

Cancer fear and the interpretation of ambiguous information related to

First published on: 19 May 2008

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Cancer fear and the interpretation of ambiguous

Correspondence should be addressed to: Anne Miles, Department of Epidemiology and

further exploration within a more experimentally controlled approach, using

different in meaning, e.g., dye/die; e.g., Mathews, Richards, & Eysenck,

similar they were in meaning to the original scenarios. These sentences

Low fear (n31) High fear (n16)

Age 61.26 (4.92) 60.46 (5.79)

obvious). The 10 social scenarios had been used in previous research

Participants were given immediate feedback as to whether they had answered

Test sentences. Four disambiguated sentences were developed for each

These four sentences were presented in random order, in a block, and

Validity ratings. To check the content validity of the scenarios, eight

‘‘I rarely worry about seeming foolish to others’’ (true; false).

Verbal IQ. Verbal IQ was assessed with the Spot-the-Word Test, a

First, participants read through two neutral practice scenarios followed by a

arrow) within 8 seconds. Participants were given direct feedback on their

poor ability to discriminate between related and non-related items. Response

Low fear (n30) High fear (n16)

To clarify this three-way interaction, it was decomposed by valence with

statements as similar to the ambiguous originals relative to the low-fear

results apparently more consistent with the latter findings, although we do

observed here. This explanation seems unlikely to provide a complete

for negative inferences to be drawn from cancer information in order to

Manuscript received 12 December 2007

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