Notes
This book gives general information. It isn't medical advice, and it's no substitute for a doctor, dentist, pharmacist or nurse who can examine you. If you think something may be an emergency, call 999 or use NHS 111.
I've kept sources out of the chapters where I could so they read easily. Here they are by chapter, with the limits I'm aware of. Unless I say otherwise, I read the published summary of each paper and not the full text. I checked each paper for a retraction notice in September 2026 and found none. Where a chapter isn't listed, it rests on my own reasoning. That includes chapters 1, 3, 9, 13 and 15 apart from the sources named in them. The NHS and Cancer Research UK pages were read in September 2026. They describe services in England. Screening ages, booking arrangements and charges differ elsewhere and change over time.
Before you start. The 999 criteria are from the NHS page "Chest pain". The description of health anxiety is from the NHS page "Health anxiety".
Chapter 2. Taber, Leyva and Persoskie, "Why do people avoid medical care? A qualitative study using national data", Journal of General Internal Medicine 30, 2015, pages 290 to 297. The survey was American, where cost and insurance are much larger barriers than in the NHS. Of 1,369 people, 58.4 per cent named traditional barriers such as cost and time, 33.3 per cent gave unfavourable evaluations of seeking care, and 12.2 per cent reported low perceived need. Smith, Pope and Botha, "Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis", Lancet 366, 2005, pages 825 to 831. The list of four reasons is mine.
Chapter 3. Persoskie, Ferrer and Klein, "Association of cancer worry and perceived risk with doctor avoidance: an analysis of information avoidance in a nationally representative US sample", Journal of Behavioral Medicine 37, 2014, pages 977 to 987. The pattern I describe was found in people aged fifty and over. In younger people it was perceived risk, and not worry, that went with avoidance. It's a survey and can't show cause.
Chapter 4. The statements about moles and breast lumps are from the NHS pages "Moles" and "Breast lump". The comparison of the two kinds of relief is mine.
Chapter 5. The survival figures are from the Cancer Research UK page "Why is early diagnosis important?", which draws on NHS England's "Cancer survival in England" for cancers diagnosed from 2016 to 2020. They're age-standardised net survival for stage 1 against stage 4. Neal and twenty colleagues, "Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review", British Journal of Cancer 112, supplement 1, 2015, pages S92 to S107. Hanna and nine colleagues, "Mortality due to cancer treatment delay: systematic review and meta-analysis", BMJ 371, 2020, m4087. The remarks about fillings and blood pressure are general knowledge and I haven't sourced them beyond the NHS pages "Dental check-ups" and "NHS Health Check".
Chapter 6. Cromme, Whitaker, Winstanley, Renzi, Smith and Wardle, "Worrying about wasting GP time as a barrier to help-seeking: a community-based, qualitative study", British Journal of General Practice 66, 2016, pages e474 to e482. What I say about pharmacists, online forms and how clinicians regard embarrassment is my understanding and isn't sourced.
Chapter 7. Armfield, Stewart and Spencer, "The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear", BMC Oral Health 7, 2007, article 1. It's a survey taken at one point in time, so it's consistent with a cycle and can't prove one. The check-up intervals are from the NHS page "Dental check-ups". The advice to tell the dental team you're anxious is from the NHS page "What happens when you visit the dentist". The options for cervical screening are from the "What happens" page of the NHS guide to cervical screening. That some areas have dental services for very anxious patients is from my general knowledge and I haven't checked it.
Chapter 8. Vrinten, Waller, von Wagner and Wardle, "Cancer fear: facilitator and deterrent to participation in colorectal cancer screening", Cancer Epidemiology, Biomarkers and Prevention 24, 2015, pages 400 to 405. The odds ratio for attendance among people who found thoughts of cancer uncomfortable was 0.72. The screening in that trial was an examination with a flexible camera, not the home kit now used. Howell and Shepperd, "Reducing information avoidance through affirmation", Psychological Science 23, 2012, pages 141 to 145. Applying it to a real phone call is my step.
Chapter 9. That most adults pay for NHS dental treatment, in three bands by complexity, is from the NHS page "How much NHS dental treatment costs".
Chapter 10. The descriptions are from the NHS pages "Bowel cancer screening", "Cervical screening", "Breast screening (mammogram)" and "NHS Health Check". What I say about false alarms and about finding conditions that would never have caused harm is a general statement about screening. I haven't sourced it, and the balance differs between programmes. The leaflet sent with each invitation is the place to read about a particular test.
Chapter 11. None of the practical routes was checked in detail, and the chapter says so.
Chapter 12. Sheeran and Orbell, "Using implementation intentions to increase attendance for cervical cancer screening", Health Psychology 19, 2000, pages 283 to 289. The advice about the appointment itself is mine.
Chapter 13. Gollwitzer and Sheeran, "Implementation intentions and goal achievement: a meta-analysis of effects and processes", Advances in Experimental Social Psychology 38, 2006, pages 69 to 119. The rule and its four parts haven't been tested together, and what I say to expect is my expectation and not a finding.
Chapter 14. The statement about breast clinic tests is from the NHS page "Breast lump". The signs of health anxiety are from the NHS page "Health anxiety".