Summary The 28-item GHQ was used to assess psychiatric morbidity in 302 women attending for routine breast cancer screening, 300 women attending for further investigation of a positive screening result and 150 women referred for investigation of breast symptoms. The GHQ-28 was administered on arrival at the relevant clinic and three months later. Medical records were used to determine the outcome of the clinic attendance. Women were classified into routinely screened women, women with false positive screening results, symptomatic women with a benign diagnosis, newly diagnosed cancer patients and previously treated cancer patients. When tested on arrival at the clinic, 25% of routinely screened, 30% of women with false positive results and 35% of symptomatic women with benign conditions were probable cases of psychiatric morbidity. The only statistically significant difference was between the routinely screened and symptomatic benign groups. Levels of anxiety were significantly higher in those with false positive results and in the symptomatic benign group than in the routinely screened. Three months later the prevalence of probable psychiatric morbidity had fallen to 19% in both the routinely screened and those with false positive results but remained significantly higher in the symptomatic benign group (31%). Probable cases of psychiatric morbidity among newly detected cancer patients rose from 34 to 46% over the 3-month period. Among women who had had breast cancer diagnosed in the past prevalence remained at 21 %. The prevalence of probable psychiatric morbidity in screened women is similar to that in the general population. Among women referred for further investigation because of a false positive screening result prevalence was only slightly increased and there was no evidence of a sustained increase in anxiety. Provided that delays are kept to a minimum and that women are kept informed, a breast cancer screening programme does not increase psychiatric morbidity. Further research is required in cancer patients to determine whether those diagnosed in asymptomatic women have a higher and more sustained degree of psychiatric morbidity than those diagnosed in women who are aware of symptoms.Concern has been expressed that screening for breast cancer may have adverse psychological effects. The invitation for screening may make women more aware of their vulnerability and hence increase anxiety. Recalling women who are found to have an abnormality on screening for further investigation (currently 5-10% of those screened in the UK) may cause distress which is hard to alleviate even when further investigations are negative. Those who are symptom-free on screening but are found to have cancer could find it especially hard to adapt to the diagnosis (Maguire, 1982).The first concern has been partially investigated in Edinburgh (Dean et al., 1986). It was found that women attending for screening had no excess psychiatric morbidity compared to other women in the same age-group, (although little is yet known about morbidi...
The effect on the detection and characteristics of melanoma, resulting from the Cancer Research Campaign's health education programme to promote the early detection of melanoma in the general population, was studied from 1987 to 1989. The seven study areas in England and Scotland yield a target population of 3.6 million. Data were collected from local clinic-based registers, pathology laboratories, and the cancer registries. The average annual incidence rates of melanoma were seven and 12 per 10(5) in males and females, respectively, age-standardized to England and Wales, 1988. These rates are similar to the national figures for Scotland, where there is a national melanoma register, but higher than those reported by the English and Welsh cancer registries. The incidence was significantly higher in females than males (P < 0.001), and increased with age. Fifty-three per cent and 65% of cases in males and females, respectively, were thin (Breslow thickness < or = 1.5 mm), similar to the national figures from Scotland. No significant decrease in the incidence of late-stage tumours was found in either sex as a result of the campaign. Because of difficulties with ascertainment of cases in England, the main evaluation will focus on future trends in mortality rates for melanoma.
From 1987 to 1989 a campaign to promote the early detection of cutaneous malignant melanoma was conducted in the areas of seven health authorities in England and Scotland (total population 3.6 million). Data were collected on 17,155 patients attending pigmented lesion clinics (PLCs) in each study area during the campaign. After a dramatic rise in PLC referral rates in the first month of the campaign the average monthly referral rate among the target population in the study period settled to an average of 13 per 10(5), a twofold increase compared with the pre-campaign period. Over 85% of patients at all PLCs were seen within 4 weeks of referral from their general practitioners. The melanoma to non-melanoma detection ratio was (1:33). The organization of future early detection initiatives needs careful review and planning, in order to improve their effectiveness in all sections of the population, and to enable health services to cope with the increased work-load.
Objective-The aim was to assess the extent to which selection bias affects a casecontrol study of breast cancer screening in which attenders and non-attenders for screening are compared.Design-There were two retrospective case-control studies, one estimating the risk ofdeath from breast cancer in women in the screening district relative to those in the comparison district (study A), the second estimating the relative risk for women who had ever been screened compared with women who had never been screened in the screening district alone (study B The evidence to date for the effectiveness of screening in reducing mortality from breast cancer has come from randomised trials,'4 from population based studies for which control populations were available,5 and from case-control studies conducted for population based screening programmes with no control population.6-8The United Kingdom trial of early detection of breast cancer (TEDBC), while not a randomised trial, included four separate "comparison" populations, from which the same data on breast cancer incidence and mortality were collected as in the four "intervention" districts.9 The first results on mortality from this trial showed a reduction in breast cancer mortality in the two districts offering annual screening of 140% relative to the comparison districts; this reduction increased to 20% when the breast cancer mortality in the different districts in the 10 year period before the start of the trial was taken into account.5The present study is a case-control evaluation comparing one of the screening districts with one of the comparison districts in this trial. A second case-control evaluation was conducted solely within the screening district, and compared screened and unscreened women. The purpose of undertaking two studies was to assess the extent of selection bias in the latter comparison. A subsidiary aim was to collect additional information on risk factors in order to estimate any underlying difference between the two districts and the extent to which such differences might have affected the results of the trial. MethodsThe methodology of the trial has been described in detail elsewhere. The present study includes data from Guildford, where screening was offered to all women aged 45-64 years by mammography and clinical examination every two years, with clinical examination in the intervening years; and Stoke-on-Trent, which acted as one of the comparison districts. In both districts the entire trial population has been flagged at the National Health Service Central Registry, which supplies the TEDBC coordinating centre with information on all breast cancer registrations and deaths. In Guildford, 72% of women accepted the initial invitation to screening and information on a number of risk factors for breast cancer was
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