Psychosocial consequences of false positives in the Danish Lung Cancer CT Screening Trial: a nested matched cohort study

Abstract

ObjectivesLung cancer CT screening can reduce lung cancer mortality, but high false-positive rates may cause adverse psychosocial consequences. The aim was to analyse the psychosocial consequences of false-positive lung cancer CT screening using the lung cancer screening-specific questionnaire, Consequences of Screening in Lung Cancer (COS-LC).Design and settingThis study was a matched cohort study, nested in the randomised Danish Lung Cancer Screening Trial (DLCST).ParticipantsOur study included all 130 participants in the DLCST with positive CT results in screening rounds 2–5, who had completed the COS-LC questionnaire. Participants were split into a true-positive and a false-positive group and were then matched 1:2 with a control group (n=248) on sex, age (±3 years) and the time of screening for the positive CT groups or clinic visit for the control group. The true positives and false positives were also matched 1:2 with participants with negative CT screening results (n=252).Primary outcomesPrimary outcomes were psychosocial consequences measured at five time points.ResultsFalse positives experienced significantly more negative psychosocial consequences in seven outcomes at 1 week and in three outcomes at 1 month compared with the control group and the true-negative group (mean ∆ score >0 and p<0.001). True positives experienced significantly more negative psychosocial consequences in one outcome at 1 week (mean ∆ score 2.86 (95% CI 1.01 to 4.70), p=0.0024) and in five outcomes at 1 month (mean ∆ score >0 and p<0.004) compared with the true-negative group and the control group. No long-term psychosocial consequences were identified either in false positives or true positives.ConclusionsReceiving a false-positive result in lung cancer screening was associated with negative short-term psychosocial consequences. These findings contribute to the evidence on harms of screening and should be taken into account when considering implementation of lung cancer screening programmes.Trial registration numberNCT00496977.

Psychosocial consequences of a three-month follow-up after receiving an abnormal lung cancer CT-screening result: A longitudinal survey

“…Screening, in its own right, introduces the risk of negative psychosocial consequences which might be long-term. However, in the previously mentioned matched cohort study we found short-term, but no evidence supporting long-term psychosocial consequences [13]. We argue that certain long-term consequences may have been overlooked, or that the development of a certain resilience or relief (of feeling cured) may play a long-term role [13].…”

“…The questionnaire Consequences of Screening -Lung cancer (COS-LC) is a condition-specific questionnaire with high content validity and adequate psychometric properties developed and validated, using Item Response Theory Rasch models, to measure the psychosocial consequences of participation in lung cancer CT-screening [5,13]. COS-LC has two parts; Part 1 includes the nine scales (number of items); Anxiety (7), Behaviour (7), Sense of dejection (6), Negative impact on sleep (4), Self-blame (5), Focus on airway symptoms (2), Stigmatisation (4), Introvert (4) and Harm of smoking (2).…”

“…Also, a cohort study found that women who had to wait six months until final diagnosis were more distressed than women who had cancer ruled out immediately after the clinical mammography screening [21]. Further, in a matched cohort study using data from the DLCST, patients who received a true-positive screening result and thereby a cancer diagnosis scored 4 points on the anxiety scale measured one week after diagnosis [13]. In our study, the mean anxiety score was 3.25 measured just before the three-month follow-up CT-scan.…”

“…Other studies have applied generic questionnaires [10]; however, these generic measures lack content and construct validity as they are not developed to measure all psychosocial aspects important for this target group [6,7,11,12]. A recent study using the COS-LC found that receiving a false positive result in the DLCST was associated with negative short-term psychosocial consequences [13]. Still, this study did not investigate the potential psychosocial consequences emerging in the waiting-time, often called the critical period, from before the annual screening until the three-month follow-up, at which the cancer suspicion raised at screening is either confirmed or rejected.…”

Outcomes in CME/CPD - Special Collection: How to make the “pyramid” a perpetuum mobile

“…favouring sensitivity over specificity) [e.g. 28 , 29 ]. There is currently no universally agreed concept on how to translate evidence into language, and current concepts are inconsistent and/or difficult to put into practice [ 30–32 ].…”