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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Jenkins, Valerie 
Fallowfield, Lesley 
Langridge, Carolyn 
Ryan, Andy 

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.

Aged, Anxiety, Early Detection of Cancer, Female, Follow-Up Studies, Humans, Middle Aged, Multimodal Imaging, Ovarian Neoplasms, Prognosis, Psychology, Risk Factors, United Kingdom
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Int J Gynecol Cancer
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Medical Research Council (MR/L003120/1)
Medical Research Council (MR/K014811/1)
MRC (MR/L501566/1)
British Heart Foundation (None)
VF and JB were supported by the MRC (Unit Programme number U105261167 and grant number G0902100) and UM by National Institute for Health Research University College London Hospitals Biomedical Research Centre.