Psychological outcomes of familial ovarian cancer screening: No evidence of long-term harm

Brain, Katherine Emma; Lifford, Kate; Fraser, Lindsay; Rosenthal, Adam N.; Rogers, Mark T.; Lancastle, Deborah; Phelps, Ceri; Watson, Eila; Clements, Alison; Menon, Usha

doi:10.1016/j.ygyno.2012.08.034

Cited by 18 publications

(33 citation statements)

References 29 publications

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“…16 Also, the familial OC screening study showed that withdrawal was associated with greater cancer-specific distress, 17 although this was found to be transient. 18 A more detailed analysis and description of the multiple factors influencing withdrawal from UKCTOCS is currently being prepared.…”

Section: Main Findingsmentioning

confidence: 99%

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

Barrett

Jenkins

Farewell

et al. 2014

BJOG

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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

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Section: Main Findingsmentioning

confidence: 99%

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

Barrett

Jenkins

Farewell

et al. 2014

BJOG

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“…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;.…”

Section: Introductionmentioning

confidence: 99%

“…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;. Women at high risk for familial OC receiving a FP TVS screening test result (n = 64) evidenced increased cancer worry and general distress and decreased well-being in the short-term (Wardle et al, 1993) with only cancer worry remaining elevated, relative to women receiving normal screening test results, at one year follow-up (Wardle et al, 1994).…”

Section: Introductionmentioning

confidence: 99%

“…Women at high risk for familial OC receiving a FP TVS screening test result (n = 64) evidenced increased cancer worry and general distress and decreased well-being in the short-term (Wardle et al, 1993) with only cancer worry remaining elevated, relative to women receiving normal screening test results, at one year follow-up (Wardle et al, 1994). Similarly, women at high risk for familial OC reported increased OCspecific distress 1 week after receiving an abnormal test result (n = 167) and were more likely to withdraw from future OC screening (Brain et al, 2012). Increased OCspecific distress was not apparent at later follow-up and no impact was evident on measures of reassurance and general anxiety and depression.…”

Section: Introductionmentioning

confidence: 99%

“…In general, the evidence suggests receipt of a FP OC screening test result definitely increases cancer-specific and OC-specific worry and distress in the short-term (Andrykowski et al, 2004;Brain et al, 2012;Wardle et al, 1993) and possibly in the long-term (Andersen et al, 2007;Wardle et al, 1994). 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).…”

Section: Introductionmentioning

confidence: 99%

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

2017

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While participation in cancer screening can facilitate early detection and improved prognosis, all screening tests yield some proportion of abnormal test results which are later determined benign. These false positive (FP) results can negatively impact affective, cognitive, and behavioral outcomes. Women participating in an ovarian cancer (OC) screening program receiving an abnormal screening test result (n = 375) were matched with women receiving normal results (n = 375). Both groups completed a baseline and 1- and 4-month follow-up assessments. FP test results were clearly associated with increased cancer-specific distress and increased perceptions of OC risk with more limited evidence for increased perceived positive consequences of screening and increased intentions to participate in future OC screening. FP OC screening test results negatively impact both affective and cognitive outcomes which may serve to reduce motivation to participate in future routine screening. The development and testing of brief, timely interventions to minimize this negative impact is warranted.

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Ovarian cancer prevention and screening

Gentry‐Maharaj¹,

Griffin²,

Menon³

2018

Cancer Prevention and Screening

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Précis Advances in ovarian cancer prevention and screening include improved risk-prediction models, mounting use of bilateral salpingectomy, proven stage shift with multimodal screening, superior performance of longitudinal biomarker algorithms compared to cutoffs and an increasing focus on tumour DNA both in blood and novel specimens, such as cervical cytology samples. 17-1873R1 Menon 2-9-18v4 4 Abstract (word count: 308) There has been much progress in ovarian cancer screening and prevention in recent years. Improved tools that combine genetic and epidemiological factors to predict an individual's ovarian cancer risk are set to become available for tailoring preventative and screening approaches. The increasing evidence on tubal origins of a proportion of ovarian cancer has paved the way to use of opportunistic bilateral salpingectomy at tubal ligation and hysterectomy in the general population. Clinical trials are in progress to estimate the long-term effects on endocrine function. In women at high risk, risk reducing salpingo-oophorectomy remains the standard of care with the current focus on management of resulting non-cancer outcomes, especially sexual dysfunction in younger women. This has led to evaluation of early bilateral salpingectomy and delayed oophorectomy in this population. Meanwhile, modelling suggests that BRCA mutation carriers should consider using the oral contraceptive pill for chemoprevention. In the general population, the largest ovarian cancer screening trial to date, the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), reported a stage shift with annual multimodal screening using the longitudinal CA125 Risk of Ovarian Cancer Algorithm (ROCA) but not with annual transvaginal ultrasound screening. There was no definitive mortality reduction with either screening strategy compared with no screening. Further follow-up till December 2018 in now underway. Stage shift and higher rates of optimal cytoreduction were also reported during 3-4 monthly multimodal screening in the United Kingdom and U.S. high-risk screening trials. While all agree that there is not yet evidence to support general population screening, recommendations for high-risk screening vary between countries. A key finding from the screening trials has been the better performance of longitudinal algorithms compared to a single cutoff for CA125. A major focus of ovarian cancer biomarker discovery work has been tumour DNA markers both in plasma and novel specimens, such as cervical cytology samples.

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Psychological outcomes of familial ovarian cancer screening: No evidence of long-term harm

Cited by 18 publications

References 29 publications

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

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

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

Ovarian cancer prevention and screening

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