Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening

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 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, 1.36Y1.56; P e 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 G 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 inUKCTOCS. Having a high predisposition to anxiety, high current state anxiety, and above threshold general psychological morbidity all increased the withdrawal rate.

 Interpretation
There are no other OCS studies of comparable design
and size with which to compare these UKCTOCS withdrawal
results. What we have shown is that women with a high
predisposition toward anxiety are more likely to drop out of
screening, as do those who experience high anxiety after their
most recent scan. Furthermore, the more invasive the initial
screening procedure is, that is TVS, rather than a multimodal
approach, the more likely withdrawal will be after a repeat
scan or false-positive result.

CONCLUSIONS
The United Kingdom Collaborative Trial of Ovarian
Cancer Screening included a comprehensive psychosocial
arm that has permitted an in-depth appraisal of not only the
psychosocial harms and benefits of OCS but also some of the
factors that might enhance or inhibit attendance and re attendance.
Next year, the National Screening Committee is
scheduled to review its policy on OCS in women after the
UKCTOCS study against criteria that include psychosocial
factors. These results should assist policy makers when
considering the optimal screening methods and any accompanying
educational resources, especially aimed at ameliorating
anxiety.