title: Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening.
abstract: OBJECTIVE
  The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) aims to establish the efficacy of 2 different ovarian cancer screening schedules. The psychosocial substudy examines the psychological factors associated with the screening program.
  
  
  METHODS
  Women aged 50 to 75 years from 16 UK gynecologic centers randomized to annual multimodal screening or ultrasound screening (US) groups were followed up for 7 years. Psychosocial data from women who withdrew from the study after a repeat screen were examined.
  
  
  RESULTS
  Sixteen percent (3499/21,733) of women requiring a repeat screening test in addition to annual screen withdrew from the study: 12.9% (1560/12,073) from the multimodal group and 20.1% (1939/9660) from the US group. An estimated relative risk of withdrawal is 1.46 (95% confidence interval, 1.36-1.56; P ≤ 0.001) for the US arm. High anxiety trait and increased psychological morbidity significantly influenced withdrawal, even when age, screening center, and group were taken into account (P < 0.001). The risk of withdrawal decreased significantly the longer a woman stayed in UKCTOCS, irrespective of the number of screens and intensity in the preceding year.
  
  
  CONCLUSIONS
  Withdrawal rate was greater in women undergoing US screening and in those who had repeats earlier in UKCTOCS. Having a high predisposition to anxiety, high current state anxiety, and above threshold general psychological morbidity all increased the withdrawal rate.
authors.affiliation: *Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Brighton, East Sussex, UK; †Public Health and Primary Care, University of Cambridge, Cambridge, UK; ‡Women's Cancer, Institute for Women's Health, University College London, London, UK; §Chancellery Building, UNSW, Sydney NSW, Australia; and ∥MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Jenkins
authors.forename: Lesley
authors.initials: L
authors.lastname: Fallowfield
authors.forename: Carolyn
authors.initials: C
authors.lastname: Langridge
authors.forename: Jessica
authors.initials: J
authors.lastname: Barrett
authors.forename: Andy
authors.initials: A
authors.lastname: Ryan
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Justine
authors.initials: J
authors.lastname: Kilkerr
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
authors.forename: Vernon
authors.initials: V
authors.lastname: Farewell
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000523:psychology*; D011379:Prognosis; D011584:Psychology; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology