Purpose: Secondary prevention programmes have traditionally employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies involving public education and self-referral may prove more cost-effective with low risk populations for cancers with symptomatic presentation. This study, which was commissioned to inform the development of a cancer awareness campaign, aims to examine public perceptions of the early detection of cancer, the psycho-social barriers to self-referral amongst a key at-risk population and the implications for patient education. Design/methodology/approach: An exploratory study using qualitative focus groups with an at-risk population of older people living in deprived communities in west-central Scotland. Findings: The findings reveal broad support for initiatives designed to raise symptom awareness. However, fear of cancer can lead to apparently irrational responses to symptoms and subsequent delay, particularly amongst men who are less likely to seek support from lay networks. Originality/value: Early detection messages need to take account tone and symptom description to allay fears and ensure appropriate presentation. Consideration also needs to be given to the role played by lay and professional opinion formers to informing and supporting patients' decision to present with suspicious symptoms, particularly when targeting harder to reach patients of men, older people, and people living in deprived communities. (Contains 1 table.)