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Backgroundcxs  Early detection of breast cancer is effective for prolonging survival, but the participation rate in breast cancer screening among target Japanese women remains low. This study examined the relationships between tendencies in decision-making under conditions of uncertainty, health behaviors, demographics, and breast cancer screening participation in Japanese women.    Methods  Secondary analysis was performed using data from the 2017 Keio Household Panel Survey (KHPS). The study population consisted of 2945 households. Data were obtained from the KHPS for women aged 40 years or older. Breast cancer screening participation in the past year, risk aversion, time preference, health behaviors (e.g., smoking, alcohol consumption, and medical treatment received in the past year), and demographic variables were analyzed.    Results  Data from 708 women were analyzed. Among the respondents, 28.8% had attended breast cancer screening in the past year. Factors found to significantly contribute to breast cancer screening participation included higher risk aversion (odds ratio [OR], 2.34; 95% confidence interval [CI] = 1.03–5.32;  p  = 0.043), medical treatment received in the past year (OR, 1.56; 95% CI = 1.06–2.30;  p  = 0.026), higher self-rated health (OR, 1.47; 95% CI = 1.18–1.83;  p  = 0.001), living above the poverty line (OR, 2.31; 95% CI = 1.13–4.72;  p  = 0.022), and having children (OR, 1.57; 95% CI = 1.02–2.42;  p  = 0.042). Factors significantly associated with non-participation in breast cancer screening were smoking (OR, 0.20; 95% CI = 0.10–0.42;  p  < 0.000), alcohol consumption (OR, 0.56; 95% CI = 0.37–0.86;  p  = 0.007), being self-employed (OR, 0.22; 95% CI = 0.10–0.46;  p  < 0.000), and being unemployed (OR, 0.48; 95% CI = 0.26–0.90;  p  = 0.022). No significant relationship was observed between time preference and screening participation.    Conclusions  The results indicate that women who recognize the actual risk of developing breast cancer or have high awareness of breast cancer prevention tend to participate in breast cancer screening. Barriers to screening participation are not working for an organization that encourages screening and low income.

Relationship of attitudes toward uncertainty and preventive health behaviors with breast cancer screening participation