Psychological morbidity associated with ovarian cancer screening: results from more than 23 000 women in the randomised trial of ovarian cancer screening (UKCTOCS)

Abstract

Objective To examine the psychological sequelae associated with abnormal screening in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).Design Prospective, longitudinal randomised control trial.Setting Sixteen UKCTOCS centres.Sample Women aged 50-70 years randomised to annual multimodal screening, ultrasound screening or control groups.Methods Two groups were followed for 7 years: (1) a random sample (n = 1339), taken from all three study groups; and (2) an events sample (n = 22 035) of women with abnormal screens resulting in the need for repeat testing of either low or higher level intensity.Main outcome measures Patient-reported measures of anxiety (scores ranging from 20 to 80) and psychological morbidity.Results In the random sample the mean difference between anxiety scores after a repeat screening and those following an annual screening was 0.4 (95% CI À0.46, 1.27), and in the events sample it was 0.37 (95% CI 0.23, 0.51). The risk of psychological morbidity was only increased in the event sample for women requiring higher level repeat screening (OR 1.28; 95% CI 1.18, 1.39). The risk of psychological morbidity in women with ovarian cancer was higher at both 6 weeks (OR 16.2; 95% CI 9.19, 28.54) and 6 months (OR 3.32; 95% CI 1.91, 5.77) following surgery.Conclusions Screening does not appear to raise anxiety but psychological morbidity is elevated by more intense repeat testing following abnormal annual screens, and in women after surgical treatment for ovarian cancer.Keywords Anxiety, ovarian cancer, population screening programme, psychological morbidity.Please cite this paper as: Barrett J, Jenkins V, Farewell V, Menon U, Jacobs I, Kilkerr J, Ryan A, Langridge C, Fallowfield L for and on behalf of UKCTOCS trialists. Psychological morbidity associated with ovarian cancer screening: results from more than 23 000 women in the randomised trial of ovarian cancer screening

Affective, cognitive and behavioral outcomes associated with a false positive ovarian cancer screening test result

“…The impact on more generic measures of mental health is mixed with some research showing a negative impact (Barrett et al, 2014;Kauff et al, 2005;Wardle et al, 1993) and other research showing no impact (Andersen et al, 2007;Andrykowski et al, 2004;Barrett et al, 2014;Brain et al, 2012). However, this research is far from definitive.…”

“…Research has examined the impact of a FP OC screening test result (Andersen et al, 2007;Andrykowski et al, 2004;Barrett et al, 2014;Brain et al, 2012;Floyd et al, 2011;Jenkins et al, 2015;Kauff et al, 2005;Lifford et al, 2012;Wardle et al, 1993;. Much of this research has involved OC screening for women with elevated risk for OC (Brain et al, 2012;Kauff et al, 2005;Lifford et al, 2012;Wardle et al, 1993;.…”

“…In the same high risk cohort, receipt of an abnormal OC screening result (n = 470) was also associated with an increased likelihood of subsequent risk-reducing surgery to remove the ovaries and fallopian tubes (Kauff et al, 2005). The remaining studies examined women with average risk for OC (Andersen et al, 2007;Andrykowski et al, 2004;Barrett et al, 2014;Floyd et al, 201 l: Jenkins et al, 2015). Women at conventional risk for OC (i.e., B1 first degree relative with OC) receiving a FP OC screening test result (n = 32) reported increased OC-specific worry at a 2-year follow-up (Andersen et al, 2007).…”

“…No impact on measures or mood disturbance, depression, or OC risk perception was evident. A study of over 20,000 women participating in an annual OC screening program found some evidence to suggest FP test results were associated with both increased likelihood of withdrawal from the screening program (Jenkins et al, 2015) as well as increased risk for psychological morbidity (Barrett et al, 2014). No impact on state or trait anxiety was found (Barrett et al, 2014).…”

“…A study of over 20,000 women participating in an annual OC screening program found some evidence to suggest FP test results were associated with both increased likelihood of withdrawal from the screening program (Jenkins et al, 2015) as well as increased risk for psychological morbidity (Barrett et al, 2014). No impact on state or trait anxiety was found (Barrett et al, 2014). Finally, average risk women reported less interest in receiving health-related information 1 month after receipt of a FP OC screening test result (n = 279) (Floyd et al, 2011).…”