Scanxiety and Fear of Recurrence in Young Adult Female Breast and Gynaecological Cancer Survivors: Investigating Shared Mechanisms

Abstract

Background: Adolescent and young adult (AYA) females are vulnerable to psychological sequelae following cancer diagnosis and treatment. Fear of cancer recurrence (FCR) is well-documented in cancer survivors, however AYA survivors of breast and gynaecological cancers are less well-studied. Moreover, little is known about scan-related fears and anxiety ('scanxiety') in survivors of any age group.

Aims: This study aimed to assess demographic, medical, and quality-of-life correlates of FCR and scanxiety in AYA female breast and gynaecological cancer survivors post-treatment. Additionally, we explored potential shared mechanisms of FCR and scanxiety, including intolerance of uncertainty, bodily threat monitoring, and perceived stress.

Methods: AYA breast and gynaecological cancer survivors (N = 115) completed measures of FCR, scanxiety, intolerance of uncertainty, bodily threat monitoring, perceived stress, and quality of life. Bivariate associations and a structural equation model explored relationships between these variables.

Results: Both FCR and scanxiety were prevalent, with 84% reporting clinically meaningful FCR and 38% reporting severe FCR. Higher FCR and scanxiety were both associated with poorer quality of life. FCR and scanxiety were moderately associated but not entirely overlapping. Intolerance of uncertainty, bodily threat monitoring, and perceived stress were significantly correlated with both FCR and scanxiety. The structural equation model indicated that bodily threat monitoring is a plausible intermediate variable linking intolerance of uncertainty and FCR, but not scanxiety.

Conclusions: FCR and scanxiety are common in AYA survivors of breast and gynaecological cancers, with potentially distinct underlying mechanisms. Interventions targeting intolerance of uncertainty and bodily threat monitoring may reduce FCR, while further research is needed to identify therapeutic targets for scanxiety.

Keywords: adolescent and young adults (AYAs); bodily threat monitoring; breast cancer; cancer; cancer survivors; fear of cancer recurrence; gynaecological cancer; oncology; quality of life; scanxiety.

FIGURE 1

Boxplots and marginal density plots illustrating the range of scanxiety and FCR symptoms across cancer types. *p < 0.05.

FIGURE 2

Structural equation model to examine shared mechanisms of FCR and scanxiety. Value for each path represents the standardised estimate (β). Solid lines indicate statistically significant paths, p ≤ 0.05.