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Purpose Although much emphasis has been placed on the impact of ambiguity on cognitive processes, the impact of mental health disorder symptoms and racial/ethnic disparities in cancer perception of fatalism and ambiguity remains less explored. This study explored the association between mental health disorder symptoms and negative cancer perceptions. Also, we assessed differences in these outcomes within mental health disorder symptoms and racial/ethnic subgroups. Methods We used the 2019-2020 Health Information National Trends Survey data to assess the perception of cancer fatalism and cancer communication ambiguity, and employed weighted multivariable logistic regression to determine the effects of mental health disorder symptoms on these negative cancer perceptions. Results People with moderate [Adjusted Odds Ratio (AOR)= 1.58, 95% Confidence Interval (CI)= 1.09, 2.31] and severe anxiety/depression (AOR= 1.88, 95% CI= 1.12, 3.14) symptoms were more likely to have cancer fatalism perceptions than people with no anxiety/depression symptoms. People with mild (AOR= 1.33, 95% CI= 1.06, 1.69) or severe (AOR= 1.80, 95% CI= 1.03, 3.16) anxiety/depression symptoms were more likely to perceive cancer communication as ambiguous compared to people who had no anxiety/depression symptoms. Conclusions The study showed that mental health status was associated with both cancer fatalism perception and perceived ambiguity in cancer recommendations. This suggests that interventions aimed at reducing mental health disorder symptoms may potentially reduce perceived cancer fatalism and communication ambiguity, thereby improving participation in cancer prevention programs.

Purpose Although surgical resection is the main modality of treatment for breast cancer, some patients elect to refuse the recommended surgery. We assessed racial and ethnic differences in women 40 years and older who received or refused to receive surgical treatment for breast cancer in the USA and whether racial disparities in mortality were affected by their differences in the prevalence of refusal for surgical treatment. Methods We studied 277,127 women with breast cancer using the Surveillance, Epidemiology, and End Results (SEER) data and performed multivariable logistic regressions to investigate the association between surgery status of breast cancer and race/ethnicity. Additionally, we performed Cox regression analyses to determine the predictors of mortality outcomes. Results Of 277,127 patients with breast cancer, 1468 (0.53%) refused to receive the recommended surgical treatment in our cohort. Non-Hispanic Black women were 112% more likely to refuse the recommended surgical treatment for breast cancer compared to their non-Hispanic White counterparts [adjusted odds ratio: 2.12, 95% confidence interval (CI) 1.82–2.47]. Women who underwent breast-conserving surgery [hazards ratio (HR) 0.15, 95% CI 0.13–0.16] and mastectomy (HR 0.21, 95% CI 0.18–0.23) had lower hazard ratios of mortality as compared to women who refused the recommended treatment after adjusting for covariates. Conclusion Race/ethnicity was associated with refusal for the recommended surgery, especially among non-Hispanic Black women. Also, surgery refusal was associated with a higher risk of all-cause and breast cancer-related mortality. These disparities stress the need to tailor interventions aimed at raising awareness of the importance of following physician recommendations among minorities.