False-Positive Cancer Screens and Health-related Quality of Life

Abstract

By design, screening tests are imperfect-unresponsive to some cancers (false negatives) while occasionally raising suspicion of cancer where none exists (false positives). This pilot study describes patients' responses to having a false-positive screening test for cancer, and identifies screening effects on health-related quality of life (HRQoL). The pilot findings suggest issues important for incorporation in future evaluations of the impact of screening for prostate, lung, colon, or ovarian (PLCO) cancers. Seven focus groups were conducted to identify the nature and meaning of all phases of PLCO screening. Minnesota participants in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial who had completed screening, with at least 1 false-positive screen, participated (N = 47). Participants' reactions to abnormal screens and diagnostic work-ups were primarily emotional (eg, anxiety and distress), not physical, and ultimately positive for the majority. Health distress and fear of cancer and death were the major negative aspects of HRQoL identified. These concepts are not typically included in generic HRQoL questionnaires like the SF-36, but are highly relevant to PLCO screening. Clinicians were regarded as underestimating the discomfort of follow-up diagnostic testing. However, relief and assurance appeared to eventually outweigh the negative emotions for most participants. Implications for oncology nurses include the need to consider the emotional consequences of screening in association with screen reliability and validity.

A Qualitative Study of Lung Cancer Risk Perceptions and Smoking Beliefs Among National Lung Screening Trial Participants

“…Even participants who had received a positive screen did not seem particularly affected. This finding is discordant with the effects of false-positive mammography results, which have been found to be related to higher levels of anxiety, distress, and anxious mood (Barton et al, 2004;Brewer, Salz, & Lillie, 2007;Brodersen & Siersma, 2013;McGovern et al, 2004). This finding may be explained by NLST participants being informed about the possibility of a false-positive finding, during the screening consent (National Lung Screening Trial Research Team et al, 2011).…”

Meanings of prostate-specific antigen testing as narrated by men with localized prostate cancer after primary treatment

“…A cancer screening trial [31] among patients in the USA with prostate, lung, colorectal and ovarian cancer showed that abnormal screens produced experiences of anxiety, distress, fear and death. Despite these experiences, most patients in the study saw the screening as being ultimately positive.…”

Screening of high-risk groups for breast and ovarian cancer in Europe: a focus on the Jewish population

“…As a consequence, in order to find 26 cases of ovarian cancer (plus 3 other malignancies), 570 women underwent a surgical procedure [155]. The deleterious consequences of such poor specificity included poorer adherence to the PLCO Trial, as well as emotional distress [156]. This underscores the need for methods that more accurately detect ovarian cancer, particularly for women at high risk, and, as discussed, efforts in this direction are ongoing [7][8][9][10].…”