False-positive screening events and worry influence decisions about surgery among high-risk women

Abstract

Objective: Studies of cancer screening have found that false positive screening events (FPSE) can affect worry about cancer risk and screening program use, we sought to further explore this.

Method: In a study of 1,100 women at high risk for ovarian cancer who participated in a previously published randomized controlled trial (RCT), we sought to explore whether worry might also influence the use of risk-reducing surgical procedures by women. Participants included 234 women with BRCA1/2 mutations and 866 women with high-risk pedigrees. We followed the women for up to 6 years.

Results: Worry predicted risk reducing prophylactic bilateral salpingo-oophorectomy (pBSO) for both mutation carriers (HR = 1.74; p = .02), and women with high-risk pedigree (HR = 3.41; p < .001). FPSE also predicted subsequent pBSO among women with a high-risk pedigree (HR 2.31; p < .01). While screening may reduce worry among those who never receive a positive result, FPSE increase worry at least temporarily. Worry about ovarian cancer risk predicted use of preventative pBSO among high-risk women including those with BRCA1/2 mutations enrolled in an ovarian cancer-screening program. FPSE also predicted risk-reducing ovarian surgery among high-risk women without a known mutation at the time of screening program enrollment.

Conclusions: Physicians who offer screening should know that false positive results may increase use of pBSO, how this should effect clinical practice is unclear. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT01121640.

Figures

Figure 1.. Participant Flow through the Protocol.

*includes women who are: currently pregnant or undergoing radiation or chemotherapy for cancer with the exception of tamoxifen or armatase inhibitors +/− Lupron.

Figure 2:. Riverplot of participant transitions in a screening

Women transitioning to surgery and to censoring at screen #8 (loss to follow-up (n = 54), dropout (n = 97), oophorectomy for other cause (n = 23), or end of study (n=976)) over time are also shown. Levels of worry recorded at confirmatory screens following a FPSE appear at the bottom of the figure. P1-P8: Primary Screens 1-8 C1-C8: Confirmatory Screens 1-8

Figures 3:

Kaplan-Meier curves showing rates of pBSO in women with BRCA1/2 mutations (N=229) and those with significant pedigree (N=862), stratified by ovarian cancer worry

Figures 4:

Kaplan-Meier curves showing rates of pBSO in women with BRCA1/2 mutations (N=229) and those with significant pedigree (N=862), stratified by ovarian cancer worry

Figures 5:

Kaplan-Meier curves showing rates of pBSO in women with BRCA1/2 mutations (N=229) and those with significant pedigree (N=862), stratified by FPSE

Figures 6:

Kaplan-Meier curves showing rates of pBSO in women with BRCA1/2 mutations (N=229) and those with significant pedigree (N=862), stratified by FPSE