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Broad participation in screening is key to cancer prevention and early detection. Unfortunately, screening rates are low for many modalities. At its core, successful screening involves an individual deciding to take action (eg, completing self-exams or scheduling appointments). Therefore, the science of decision making is central to understanding and increasing screening adherence. In this commentary, we (the members of ASPO's Behavioral Oncology Interest Group) consider the state of the science on screening decision making and recommend research directions to advance the field. We address three key areas: implications of the nature of screening behavior for understanding decision making, expanding current decision-making theories to consider other influences on behavior, and using decision science findings to develop effective interventions.