Background. Lung cancer screening can result in a high rate of indeterminate findings and has not yet been proven to be efficacious in reducing mortality. To date, the psychological consequences of receiving an indeterminate screening result are not known.Methods.Four hundred individuals were recruited into this study. Participants completed 4 surveys: baseline, after lung screening results were known, and at 6 and 12 mo after screening. Demographics, state/trait anxiety, fear of cancer, and perceived risk of lung cancer were measured. Mixed-model regressions were used to determine whether the levels and time trends of outcome variables were different among individuals with different screening outcomes.Results.An indeterminate screening result increased state anxiety of participants, although anxiety then decreased over time. The objective risk of cancer is lower for individuals with an indeterminate screen than their initial perceived risk, and screening did not change their perceived risk of cancer. Those with a suspicious screening result had increased perceived risk of cancer and fear of cancer after screening, and these effects also diminished over time. Individuals with a negative screen had a temporary reduction in perceived risk of cancer.Conclu sions.Individuals who are screened for lung cancer and receive an indeterminate or suspicious screening result have some negative psychological effects from being screened. The results suggest that individuals who are considering screening should be fully informed of the risk of negative psychosocial consequences and that individuals who have been screened should receive clear and detailed information on interpreting screening results.
Patz EFJ , Goodman PC, Bepler G.Current concepts: screening for lung cancer . N Engl J Med . 2000;343(22):1627-33.
2.
Jemal A., Murray T., Ward E., et al. Cancer statistics, 2005. CA Cancer J Clin.2005;55(1):10-30.
3.
Henschke CIEarly lung cancer action project: overall design and findings from baseline screening. Cancer. 2000;89(11):2474-82.
4.
Ellis SM, Husband JE, Armstrong P., Hansell DMComputed tomography screening for lung cancer: back to basics. Clin Radiol. 2001;56:691-9.
5.
Dominioni L. , Strauss G.Consensus statement. Suppl Cancer. 2000;89(11):2329-30.
6.
Sone S., Takashima S., Li F., et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet. 1998; 351:1242-5.
7.
Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet. 1999;354:99-105.
8.
Kaneko M., Kusumoto M., Kobayashi T., et al. Computed tomography screening for lung carcinoma in Japan. Cancer. 2000;89: 2485-8.
9.
Diederich SM , Wormanns DM, Lenzen HM, Semik MM, Thomas MM, Peters PEM.Screening for asymptomatic early bronchogenic carcinoma with low dose CT of the chest . Suppl Cancer. 2000;89(11):2483-4.
10.
Henschke CI , Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS; International Early LungCancer Screening ActionProgram Investigators.Survival of patients with stage I lung cancer detected on CT screening. New Engl J Med. 2006; 355(17):1763-71.
11.
Black WCOverdiagnosis: an underrecognized cause of confusion and harm in cancer screening . J Natl Cancer Inst. 2000; 92(16):1280-2.
12.
Marcus PM, Bergstralh EJ, Zweig MH, Harris A., Offord KP, Fontana RSExtended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis . J Natl Cancer Inst. 2006 ; 98(11):748-56.
Lerman C., Smith D., Nolte S., Hanjani P., Scarborough R., Miller SMAdverse psychologic consequences of positive cytologic cervical screening . Am J Obstet Gynecol. 1991;165(3):658-62.
15.
Broadstock M., Marteau T., Michie S.Psychological consequences of predictive genetic testing: a systematic review. Eur J Hum Genet. 2000;8(10):731-8.
16.
Wiggins S., Hayden MR, Schechter MT, et al. The psychological consequences of predictive testing for Huntington's disease. Canadian Collaborative Study of Predictive Testing. N Engl J Med. 1992;327(20):1401-5.
17.
Ong G., Brett J., Austoker J.Breast screening: adverse psychological consequences one month after placing women on early recall because of a diagnostic uncertainty. A multicentre study . J Med Screen. 1997;4(3):158-68.
18.
Cockburn J., Staples M., Hurley SF, DeLuise T.Psychological consequences of screening mammography. J Med Screen. 1994; 1(1):7-12.
19.
Lampic C., Thurfjell E., Sjoden POThe influence of a false-positive mammogram on a woman's subsequent behavior for detecting breast cancer. Eur J Cancer. 2003;39(12):1730-7.
20.
Swanson V., Dobson H., Power KG, McIntosh IBThe psychological effects of breast screening in terms of patients' perceived health anxieties. Br J Clin Pract. 1996;50(3):129-35.
21.
Aro AR, Absetz SP, van den Elderen TM, van der Ploeg E., van der Kamp LJFalse-positive findings in mammography screening induces short-term distress-breast cancer specific concern prevails longer. Eur J Cancer. 2000;36:1089-97.
22.
Lowe JB, Hawes E., Del Mar C., Balanda KPPsychologic distress in women with abnormal findings in mass mammography screening . Cancer. 1999;85(5):1114-8.
23.
Spielberger CDManual for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press; 1983.
24.
McDowell I., Newell C.Measuring Health: A Guide to Rating Scales and Questionnaires. 2nd ed. New York: Oxford University Press; 1996.
25.
Idestrom M. , Milsom I., Andersson-Ellstrom A.Women's experience of coping with a positive Pap smear: a register-based study of women with two consecutive Pap smears reported as CIN 1. Acta Obstet Gynecol Scand. 2003;82(8):756-61.
26.
Strecher VJ , Kreuter MW, Kobrin SCDo cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks?J Behav Med . 1994;18(1):45-54.
27.
Ayanian JZPerceived risks of heart disease and cancer among cigarette smokers . JAMA. 1999;281(11):1019-21.
28.
Waljee JF, Rogers MA, Alderman AKDecision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol. 2007;25(9):1067-73.
29.
O'Connor AM , Rostom A., Fiset V., et al. Decision aids for patients facing health treatment or screening decisions: systematic review . BMJ. 1999;319(7212):731-4.
30.
Schwartz LM , Woloshin S., Fowler FJ, Welch HGEnthusiasm for cancer screening in the United States. JAMA. 2004;291(1): 71-78.
31.
Ganott MA, Sumkin JH, King JL, et al. Screening mammography: do women prefer a higher recall rate given the possibility of earlier detection of cancer? Radiology . 2006;238(3):793-800.
32.
Bratt O., Damber J.-E, Emanuelsson M., et al. Risk perception, screening practice and interest in genetic testing among unaffected men in families with hereditary prostate cancer. Eur J Cancer. 2000;36:235-41.
33.
Andrykowski MA, Carpenter JS, Studts JL, et al. Adherence to recommendations for clinical follow-up after benign breast biopsy. Breast Cancer Res Prev . 2001;69:165-78.
34.
Brewer NT, Salz T., Lillie SESystematic review: the long-term effects of false-positive mammograms . Ann Intern Med. 2007; 146(7):502-10.
35.
Hay JL, McCaul KD, Magnan REDoes worry about breast cancer predict screening behavior? A meta-analysis of the prospective evidence. Prev Med. 2006 ;42:401-8.
36.
McCaul KD, Schroeder DM, Reid PABreast cancer worry and screening: some prospective data. Health Psychol. 1996;15(6): 430-3.
37.
Moser RP, McCaul K., Peters E., Nelson W., Marcus SEAssociations of perceived risk and worry with cancer health-protective actions: data from the Health Information National Trends Survey (HINTS). J Health Psychol. 2007;12(1):53-65.
