“ The findings highlight the persistence of stigma and underscore the importance of culturally tailored interventions targeting both cancer-related and mental illness stigma .”
BUFFALO, NY — September 15, 2026 — A new research paper was published in Volume 13 of Oncoscience on August 19, 2026, titled “ Validation and psychometric properties of the Cancer Stigma Scale (CASS) in the Greek population .”
The study provides the first validation of the Cancer Stigma Scale (CASS) in the Greek context and examines how cancer-related stigma relates to attitudes toward mental illness.
The research was led by first and corresponding author Vaia Pappa from the Aristotle University of Thessaloniki, Thessaloniki, Greece , along with co-authors Diomidis Antoniadis, Konstantinos Fountoulakis and Nikitas Arnaoutoglou from the same institution.
Cancer-related stigma can affect social relationships, emotional disclosure, healthcare-seeking behavior and social integration. It has also been associated with psychological distress, social withdrawal, reduced self-esteem and impaired treatment adherence. Stigma can take multiple forms, including public, perceived, internalized and anticipated stigma, making reliable measurement important for both psycho-oncology research and the development of interventions.
The CASS was developed to measure several dimensions of cancer stigma, including avoidance, blame, policy opposition, personal responsibility, financial discrimination and perceptions of cancer severity. Before this study, however, the scale had not been validated in Greek, limiting researchers’ ability to systematically assess cancer-related stigma within this cultural context.
The researchers recruited 176 undergraduate, postgraduate and doctoral students in Thessaloniki, Greece, through convenience sampling. The participants had a mean age of 23.5 years, and 60.8% were women. Approximately 39.8% reported a personal or family history of cancer, while 35.2% reported a personal or family history of mental illness. Participants completed the CASS and the Community Attitudes toward the Mentally Ill (CAMI) scale, which allowed the researchers to examine whether attitudes toward cancer were associated with broader forms of health-related stigma.
To adapt the instruments for Greek participants, the researchers used a standardized forward-backward translation process involving independent bilingual experts and a separate back-translator. They then assessed internal consistency, construct validity and convergent validity using Cronbach’s alpha, exploratory factor analysis, Spearman correlations, regression analysis, and receiver operating characteristic (ROC) analysis.
The Greek CASS demonstrated high overall internal consistency, with a Cronbach’s alpha of 0.89. Reliability across individual subscales ranged from 0.72 to 0.86, while exploratory factor analysis generally supported the scale’s original multidimensional structure. Most items loaded onto their theoretically expected factors, providing evidence for the structural coherence and construct validity of the Greek version.
The study also revealed meaningful connections between cancer stigma and attitudes toward mental illness. Cancer-related stigma showed moderate to strong positive correlations with CAMI authoritarianism and social restrictiveness, with Spearman correlation coefficients ranging from 0.42 to 0.57. The authors interpret these relationships as evidence that different forms of health-related stigma may share underlying mechanisms involving fear, stereotyping, blame and social distancing.
However, not all statistical findings were equally strong. The regression model was not statistically significant and explained 9.6% of the variance, while ROC analyses showed limited to moderate discriminatory ability across most dimensions. Two CAMI dimensions showed acceptable discriminatory performance: Authoritarianism had an area under the curve (AUC) of 0.770, while Community Mental Health Ideology reached an AUC of 0.780. These results reinforce the view that stigma is better understood as a complex, multidimensional construct than as a simple binary characteristic.
“ The present findings further support the conceptualization of stigma as a generalized psychosocial construct operating across different health conditions .”
Demographic patterns provided additional insight. Younger participants tended to report higher cancer-related stigma, while participants with personal or family experience of illness showed lower stigma levels. The authors suggest that familiarity with serious illness may reduce negative stereotypes and encourage more empathetic attitudes, consistent with theories proposing that interpersonal contact can reduce stigma.
The Greek cultural context may also influence how cancer stigma is expressed. The authors discuss the importance of family-centered approaches to illness, communication practices and religious or fatalistic beliefs. While family and spiritual beliefs can provide important sources of support, certain patterns of silence or fatalistic interpretations may also contribute to fear, avoidance or reluctance to openly discuss a cancer diagnosis. These observations support culturally sensitive approaches to stigma reduction rather than assuming that attitudes toward cancer operate identically across populations.
The validated Greek CASS could therefore provide researchers and clinicians with a useful instrument for assessing cancer-related stigma in community and clinical settings. The authors suggest that identifying stigmatizing attitudes may help inform psychoeducational programs, supportive counseling and public-awareness initiatives. The observed relationship between cancer and mental illness stigma also points toward integrated approaches that address health-related stigma more broadly.
Important limitations remain. The study relied primarily on a young, highly educated university-based sample, limiting generalizability to older adults, oncology patients and people from more diverse socioeconomic backgrounds. Its cross-sectional design also prevents causal conclusions about the relationships observed. In addition, variance-explained indices from the exploratory factor analysis were not retained in the archived statistical outputs, limiting the completeness of the construct-validity evaluation. Future validation in larger and more diverse populations—including cancer patients, caregivers, healthcare professionals and rural communities—will therefore be important.
Overall, the study supports the Greek version of the CASS as a reliable and valid tool for assessing cancer-related stigma while highlighting the complex relationship between cancer stigma, mental illness stigma, personal experience and sociocultural factors. By providing a culturally adapted measurement tool, the research establishes a foundation for broader studies of cancer stigma in Greece and for the development and evaluation of culturally informed anti-stigma interventions.
DOI: https://doi.org/10.18632/oncoscience.669
Correspondence to: Vaia Pappa – vanpappa23@gmail.com (ORCID ID 0009-0000-6947-2784 )
Keywords: cancer stigma, mental illness stigma, CASS, CAMI, validation
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Validation and psychometric properties of the Cancer Stigma Scale (CASS) in the Greek population
19-Aug-2026
Authors have no conflicts of interest to declare.