Sumiko at 62: Worried about health screenings? Why my mammogram triggers months of anxiety

May, for me, is the cruellest month. It is the time of year I schedule my mammogram.

Whenever I am anxious, I become short-tempered, so in the weeks leading up to the breast screening, I am irritable. My mind is filled with worst-case scenarios and an endless loop of “what if they find something?”

If I get a clear result, I allow myself a few months of relief and happiness. But before long, a stray thought will remind me that next May is not all that far away. The anxiety begins as a faint hum in the background and builds to a crescendo a month or two before the appointment.

The mammogram is not the only health check that sets off this cycle of worry. Because I do my mammogram with my own doctor, it is separate from my company’s annual medical screening, which I schedule around November. Every five years, there is also a colonoscopy, and every two years, a bone density scan. Each comes with its own loop of fear. 

As you can tell, I suffer from “scanxiety”, a non-medical term combining “scan” and “anxiety” and used to describe the emotional distress some people experience before, during or while waiting for results from medical imaging and screening tests. Even something as routine as entering a clinic for a blood test can cause my blood pressure to spike.

The mammogram, however, tops my anxiety list because breast cancer is so widely talked about and feared. At my screening two weeks ago, the doctor shook her head when she saw my glum face when I entered her room. “Don’t be so nervous,” she said.

I am not alone in this.

Lim Geok Hoon, head and senior consultant at KK Breast Department at KK Women’s and Children’s Hospital (KKH), says some women experience such intense fear of breast cancer that they request a bilateral mastectomy — removal of both breasts — in order to avoid future mammograms.

“The requests have come from women who do not have breast cancer and also from those who already had it and feared recurrences,” says Lim, an associate professor.

However, such surgery is not performed unless there is a clear medical reason for it, such as those with bilateral breast cancer or who are genetic mutation carriers with a high lifetime risk of breast cancer. “Additionally, a bilateral mastectomy does not guarantee that breast cancer will not develop in the future,” she adds.

To understand health-related anxiety and what can be done to lessen it, I spoke to a range of experts.

Is it normal to feel anxious about health screenings?

Psychiatrist Lee Cheng, a senior consultant at the Institute of Mental Health (IMH), says it is completely normal to feel anxious about medical tests and screenings. 

Humans, he explains, are wired to pay attention to threats. Illness touches some of our deepest fears – pain, uncertainty, loss of control, disability, dependence and mortality.

A certain amount of concern is helpful. “It motivates people to seek care, follow up on symptoms and take preventive action,” says Lee, an adjunct associate professor and clinical director of the Office of Population Health.

The problem arises when anxiety becomes overwhelming and causes significant distress, impairment, compulsive behaviours, avoidance or repeated cycles that interfere with daily life.

Clinical psychologist Isabel Yap from the Department of Psychology at Khoo Teck Puat Hospital adds that when worry does not settle even after a clear screening result, or affects your sleep, work or ability to function normally, it may be helpful to speak to a professional.

Not all medical anxiety is the same, Yap notes.

Those with general health anxiety tend to continue worrying even after a medical event has passed. The anxiety can spill into everyday life, with minor aches and pains or even news reports about disease triggering disproportionate concern.

By contrast, some people dread specific procedures, such as injections or scans, but feel otherwise unconcerned about their health. Others experience anxiety mainly while waiting for results, with the distress tied to a period of uncertainty that typically eases once they receive their results and understand the next steps.

What happens in the brain during health anxiety?

Like other forms of fear, health-related anxiety activates multiple interconnected regions in the brain, says Lee.

The amygdala detects potential threats and triggers fear responses. The insula monitors bodily sensations and can amplify awareness of normal sensations such as your heartbeat, feeling dizzy or discomfort in your stomach. Other brain regions help to regulate uncertainty, retrieve memories and evaluate risk rationally, but these systems can become overwhelmed during intense anxiety.

“In people with strong health anxiety, the brain may become highly tuned to bodily signals and uncertainty,” Lee says. “Normal sensations get interpreted as dangerous. For example, a mild headache becomes ‘What if it’s a brain tumour?’”

At the same time, the body activates the sympathetic nervous system – the “fight, flight or freeze” response. This can cause a racing heart, elevated blood pressure, sweating, muscle tension, nausea, dizziness, dry mouth, shallow breathing and a sense of feeling detached or unreal.

“Indeed, some may feel so frightened they think they might faint,” says Lee.

Why do some feel more anxious than others?

When I was relating my fear of mammograms to a colleague, she looked puzzled. “Isn’t it good if something is spotted early?” she asked. She does not feel the same level of anxiety when she goes for her screening.

Doctors say there is no single reason why some people are more anxious than others. Instead, it is usually the result of multiple interacting psychological, biological and social factors.

Certain personality traits are more closely linked to health anxiety. These include people who experience emotions strongly and quickly, especially negative ones; who are more sensitive to threats, intolerant of uncertainty, prone to worry or rumination; and who have a strong need for control or perfection.

“Some people are also very aware of bodily sensations,” says Lee. This can lead them to check their symptoms more often.

Cognitive style also plays a role. “Some people naturally think in catastrophic terms, worst-case scenarios and all-or-nothing interpretations,” he adds.

Past experiences are important too. Yap says a previous difficult medical experience or serious illness in loved ones can all increase anxiety. Even having limited social support can make people feel more vulnerable.

Lee adds that culture and family environment shape responses. “Families differ greatly in how much illness is discussed openly, whether emotions are expressed, attitudes towards medicine, and beliefs about vulnerability and control,” he says.

KKH’s Lim says some women avoid screening due to the fear of pain from procedures or concern that a positive result could lead to financial strain and major life disruptions, including to work and caregiving duties. 

Others are influenced by previous negative experiences, such as the stress of follow-up tests and waiting for results. All this creates a cycle of anxiety that makes future screenings feel increasingly difficult. 

Mammograms, she adds, can be uncomfortable for some as the breast is compressed. Being undressed may make some women feel vulnerable and self-conscious. Some also worry about the possibility of losing a breast if cancer is detected, which can affect body image and their sense of femininity.

How some cope with fear – and how it can backfire

People use a range of coping strategies to manage screening-related anxiety, but not all are helpful in the long term.

One common response is avoidance – postponing or skipping screenings, or avoiding opening test results altogether. While this may reduce anxiety temporarily, it can reinforce fear because the uncertainty remains unresolved.

Others engage in reassurance-seeking behaviours, such as repeated visits to the doctor, constantly checking on symptoms or doing online searches, and asking friends and family for reassurance. These behaviours can bring short-term relief but tend to strengthen the anxiety cycle over time, says Lee.

Clinical psychologist Yap cites catastrophising – “mentally running through worst-case scenarios in an attempt to feel prepared” – as a common and unhelpful strategy. “While this might feel productive, it tends to backfire over time, keeping people locked in a cycle of worry and making it harder to sit with uncertainty.”

Psychiatrist Lee says others are hypervigilant, constantly scanning their body for signs of illness. Or they turn to “mild superstition to obsessive thinking”, telling themselves “if I don’t test, maybe nothing bad exists” or “talking about illness makes it more likely”.

There are also those who cope through intellectualisation, and research studies or statistics extensively.

Yet another pattern is emotional suppression. “Some detach emotionally and appear highly rational or stoic but internally ruminate constantly, and carry high physiological stress internally,” Lee says.

Coping strategies that work

The goal is not to eliminate anxiety completely, but to prevent it from becoming overwhelming.

Yap says a helpful first step is to acknowledge feelings of fear or uncertainty without immediately jumping to worst-case conclusions. 

“Feeling anxious about your health doesn’t make you weak or irrational. It makes you human,” she says. But anxiety has a way of convincing one that the worst is not only possible but inevitable. “Learning to sit with uncertainty, rather than fight it or flee from it, is one of the most powerful shifts a person can make,” Yap says.

Grounding statements can be helpful, such as telling yourself “I am feeling anxious now, but this may not necessarily mean something is seriously wrong” or “I can cope with uncertainty one step at a time”.

She advises resisting the urge to excessively read up on your symptoms before a test or while waiting for the results. This may feel reassuring in the short term, but it often increases anxiety over time. Instead, she suggests focusing on normal routines, hobbies and social connections, and staying anchored in the present.  

For persistent anxiety, psychotherapy – particularly cognitive behavioural therapy – can reshape how people respond to uncertainty, she says.

There are also practical steps around screenings themselves. 

KKH’s Lim says that if the fear of pain is stopping you from going for a mammogram, mild pain relief like a paracetamol half to one hour before, if medically appropriate, will help. Scheduling tests after menstruation will reduce discomfort, and informing healthcare staff about your anxiety can all make the process easier too.

If it is the fear of receiving a negative result that is holding you back from a mammogram, she shares this reassuring statistic: even if you are sent for a breast biopsy after a mammogram, 80 per cent of these turn up a non-cancerous finding.

She says that when breast cancer is detected through screening in women without symptoms, it is usually at an early stage which has a high five-year survival rate of above 85 per cent. Only 5 to 15 per cent of cases will be at stage three or four.

“In other words, even if you do receive a cancer diagnosis after screening, you are highly likely to have a very good survival rate after treatment,” Lim says. “Hence, do not fear the worst. Early detection is still key to better survival.”

With medical advances, treatment of many conditions has improved significantly, leading to better survival outcomes, so do not fear the test results, she adds.

Also, breast cancer does not always require a mastectomy. A lumpectomy, which involves the removal of the cancer only, can be performed with the same survival outcomes, meaning you need not lose your entire breast.

Lim adds that women who feel empowered and are equipped to cope with the outcome of the test tend to experience less fear.

Seet Meei Jiun, head and senior consultant at KKH’s Department of Obstetrics and Gynaecology, says clear communication and emotional support can reduce the fear around screenings.

Patients should be encouraged to ask questions and understand the purpose, benefits and limitations of each test, Seet says. Support from family, friends and healthcare professionals also helps patients feel less alone.

She adds that scheduling follow-up discussions promptly after a test can reduce stress during the waiting period.

As for me, I don’t think I will ever be able to eliminate my fear of mammograms or any other health check.

But what I can do is stop obsessively reading up on symptoms, rein in my tendency to catastrophise and avoid thinking in extremes – that I am either completely healthy or seriously ill. I must also train my thoughts to stay in the present rather than wander to the “what ifs” while waiting for a test or results.

And when the results do come back clear, I will try to hold on to that relief and happiness for a while longer before allowing myself to slip back into the worry loop.