The effect of ovarian cancer screening on sexual activity and functioning: results from the UK collaborative trial of ovarian cancer screening RCT

Abstract

Background:To examine the impact of multimodal (MMS) and ultrasound (USS) screening on the sexual activity and functioning of 22 966 women in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) RCT.Methods:Fallowfield's Sexual Activity Questionnaire (FSAQ) was completed prior to randomisation, then annually in a random sample (RS) of women from MMS, USS and control groups. Any women in the study who required repeat screening due to unsatisfactory results formed an Events Sample (ES); they completed questionnaires following an event and annually thereafter.Results:Over time in the RS (n=1339) there was no difference between the MMS and USS groups in sexual activity compared with controls. In the ES there were significant differences between the USS group (n=10 156) and the MMS group (n=12 810). The USS group had lower pleasure scores (mean difference=−0.14, P=0.046). For both groups women who had ⩾2 repeat screens, showed a decrease in mean pleasure scores compared with their annual scores (mean difference=−0.16, P=0.005). Similarly mean pleasure scores decreased following more intensive screens compared with annual screening (mean difference=−0.09, P=0.046).Conclusions:Ovarian cancer screening did not affect sexual activity and functioning unless a woman had abnormal results and underwent repeated or higher level screening.

Ovarian Cancer Prevention and Screening

“…Screening did not appear to raise anxiety but higher psychological morbidity (worry) and lower pleasure scores were reported by those who had to undergo Level 2 (transvaginal ultrasound with or without CA125) screening due to abnormal results on the annual screen. [123][124][125] At a median follow-up of 11.1 years, compared to the control arm, the trial demonstrated a significant (p=0.0001) stage shift in invasive epithelial ovarian, tubal and peritoneal cancers with multimodal screening (36.1% Stage I or II) compared with control (23.9%) but not with ultrasound screening (22.4%; p=0.604). 122 There was a trend to reduction in mortality which was not statistically significant in either screen arm (Figure 1).…”

Ovarian cancer screening: Current status and future directions

“…Screening for disease in the general population did not increase anxiety (91) or result in a reduction in sexual activity or functioning (92). However, an abnormal screening result and need for second line tests did result in increased psychological morbidity, primarily due to worry (91), as well as decreased sexual pleasure in the short term (92).…”

Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS: a qualitative free-text analysis

“…16 Secondary objectives include measuring the effects of screening on anxiety levels, psychological morbidity, and sexual activity, and have been published previously. 17-19…”

“…These findings were, however, not associated with ovarian screening, except for women with abnormal results who underwent repeated or higher level screening. 19…”