Optimism and participation in breast cancer screening: evidence from the United States

Abstract

This study investigates the influence of the personality trait of optimism on participation in breast cancer screening in the US. Breast cancer is the most common cancer among women in the US, accounting for approximately 30% of all new cancer diagnoses annually (American Cancer Society, 2025). Beyond sociodemographic factors, recent literature highlights the significant role of psychological factors, norms, and beliefs in the decision to participate in breast cancer screening. However, the impact of optimistic beliefs on screening uptake has not yet been explored. This study aims to address this gap.

We analyse a sample of approximately 4,500 women aged 50 and older from the US Health and Retirement Study (HRS) spanning 2006 to 2020. A dynamic probit panel data model with random effects is estimated, employing Mundlak’s (1978) approach to account for correlated individual effects. Our findings indicate that mammography uptake exhibits strong state dependence. Furthermore, optimism negatively influences mammography uptake among younger women (under 61 years) but positively affects the uptake among women aged 70 and over. These results can be interpreted through the lens of Prospect Theory (Kahneman and Tversky, 1979; Rothman and Salovey, 1997) and Socioemotional Selectivity Theory (Carstensen, 1995). Our findings suggest that policymakers should consider age-specific and psychologically tailored messaging strategies to enhance breast cancer screening adherence across diverse population groups.