title: Pre- and postmenopausal high-risk women undergoing screening for ovarian cancer: anxiety, risk perceptions, and quality of life.
abstract: OBJECTIVE
  Recommendations for women at high risk of ovarian cancer include prophylactic salpingo-oophorectomy (PSO) or screening with transvaginal ultrasonography (TVUS) and CA125 levels. The best strategy for improving survival and maintaining quality of life in high-risk women is not known. Premenopausal women may be more reluctant than postmenopausal women to undergo PSO. However, the risk of false-positive screening results may be more likely in premenopausal women, posing potential psychological risk for those enrolled in high-risk ovarian cancer surveillance programs. We sought to determine whether anxiety, depression, perception of ovarian cancer risk, and false-positive test frequency differed between high-risk premenopausal and postmenopausal women initiating ovarian cancer screening.
  
  
  METHODS
  High-risk women aged > or = 30 years enrolling in a TVUS plus CA125 ovarian cancer screening study completed standard QOL (SF-36), cancer-specific anxiety (IES), depression (CES-D), and ovarian cancer risk perception measures. CA125 > 35 and TVUS showing solid or complex cystic ovarian masses were considered abnormal. Abnormal tests were repeated after 4-6 weeks. Persistently abnormal tests prompted a search for malignancy. Tests that normalized on repeat were considered false positive.
  
  
  RESULTS
  One hundred forty-seven high-risk women, median age 46 (range, 30-78), 78 premenopausal and 69 postmenopausal, had > or = 1 TVUS/CA125/outcome assessment. Premenopausal women were more likely than postmenopausal women to consider themselves at higher risk of ovarian cancer compared with women their age (P < 0.001) and compared with women with similar family histories (P < 0.001). Mean personal perception of lifetime risk of ovarian cancer among premenopausal women was 37% (range, 0-90%) versus 26% (range, 0-60%) among postmenopausal women (P = 0.02). While general QOL and depression scores were similar, 38% of premenopausal women reported high anxiety versus 27% of postmenopausal women (P = 0.03). Thirty percent of women required repeat CA125 or TVUS after first screening; 10.8% of premenopausal women versus 4.6% of postmenopausal women required repeat CA125; and 23.3% of premenopausal and 20.6% of postmenopausal women required repeat TVUS. One postmenopausal woman with persistently rising CA125 >100 had negative mammography, colonoscopy, and dilation and curettage/bilateral salpingo-oophorectomy. All other abnormal tests normalized on repeat. Two premenopausal women withdrew due to anxiety following false-positive CA125 results. Five women (2 premenopausal, 3 postmenopausal) with normal TVUS/CA125 screening tests elected PSO, with benign findings.
  
  
  CONCLUSIONS
  Premenopausal women perceive their ovarian cancer risk to be higher, report greater ovarian cancer risk-related anxiety, and are more likely to have false-positive screening results than postmenopausal women. Few high-risk women elect PSO in the short term. Knowledge of the frequency of false-positive screening results and psychosocial outcomes is important for high-risk women choosing strategies for managing ovarian cancer risk.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1278 York Avenue, New York, NY 10021-6094, USA. hensleym@mskcc.org
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
authors.forename: Mark E
authors.initials: ME
authors.lastname: Robson
authors.forename: Noah D
authors.initials: ND
authors.lastname: Kauff
authors.forename: Beata
authors.initials: B
authors.lastname: Korytowsky
authors.forename: Mercedes
authors.initials: M
authors.lastname: Castiel
authors.forename: Jamie
authors.initials: J
authors.lastname: Ostroff
authors.forename: Karen
authors.initials: K
authors.lastname: Hurley
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Hann
authors.forename: Jasmine
authors.initials: J
authors.lastname: Colon
authors.forename: David
authors.initials: D
authors.lastname: Spriggs
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D001294:Attitude to Health; D015331:Cohort Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000523:psychology*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000523:psychology*; D017698:Postmenopause / Q000523:psychology; D017697:Premenopause / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D014463:Ultrasonography