title: 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).
  
  
  METHODS
  Prospective, longitudinal randomised control trial.
  
  
  METHODS
  Sixteen UKCTOCS centres.
  
  
  METHODS
  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.
  
  
  METHODS
  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 -0.46, 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.
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: J
authors.initials: J
authors.lastname: Barrett
authors.forename: V
authors.initials: V
authors.lastname: Jenkins
authors.forename: V
authors.initials: V
authors.lastname: Farewell
authors.forename: U
authors.initials: U
authors.lastname: Menon
authors.forename: I
authors.initials: I
authors.lastname: Jacobs
authors.forename: J
authors.initials: J
authors.lastname: Kilkerr
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.forename: C
authors.initials: C
authors.lastname: Langridge
authors.forename: L
authors.initials: L
authors.lastname: Fallowfield
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000523:psychology; D006801:Humans; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D006113:United Kingdom
keywords: Anxiety; ovarian cancer; population screening programme; psychological morbidity