Receipt of an abnormal screening test result is likely to activate an illness representation that guides emotional, cognitive and behavioural responses. The study investigates relationships between illness representations specified by self-regulation theory, and coping responses in people receiving abnormal faecal occult blood test (FOBT) screening results during the UK colorectal cancer screening pilot. After completion of all clinical investigations and treatment, men and women diagnosed with invasive cancer (N=196), adenoma (N=208), or no neoplasia (N=293) completed measures of illness representations, coping and state anxiety. Gender, socioeconomic status and diagnosis explained significant variance in different coping strategies while illness representations contributed between 5% and 21% additional explained variance. While identity, causal attributions and emotional representations explained variance in the use of avoidance and distancing, perceived personal control was important in explaining efforts to make health behavioural changes following an abnormal result. Relatively more use of escape-avoidance coping following a first abnormal screen was significantly associated with non-participation in screening 2 years later.