DOES ROUTINE SCREENING FOR BREAST-CANCER RAISE ANXIETY - RESULTS FROM A 3 WAVE PROSPECTIVE-STUDY IN ENGLAND
DOES ROUTINE SCREENING FOR BREAST-CANCER RAISE ANXIETY - RESULTS FROM A 3 WAVE PROSPECTIVE-STUDY IN ENGLAND
复制标题
DOI：
10.1136/jech.49.4.413
复制
发表时间：
1995-08-01
影响因子：
6.3
通讯作者：
HUNTER, J
中科院分区：
文献类型：
--
作者：
SUTTON, S;SAIDI, G;HUNTER, J
目的-调查是否乳房X线摄影提高焦虑的常规筛查妇女谁收到一个负面的结果。设计-前瞻性设计，其中妇女完成问卷调查，在三个关键点在乳腺癌筛查过程中：在基线（之前被发送他们的邀请乳腺癌筛查），在筛查诊所之前或之后立即筛选，并在后续行动，约9个月后基线。信息来自非参加者和参加者。设置- Bromelia区卫生局，由南东伦敦乳腺癌筛查服务。参与者-使用两个重叠的样本。样本A包括1500名年龄在50-64岁的妇女，她们将在移动的筛查单位接受第一轮筛查。共有1021人（68%）返回了可用的问卷，其中795人（78%）在9个月随访时也提供了足够的信息：有695名参加者（包括24名获得假阳性结果的女性）和100名未参加者。样本B包括868名在三个月内参加筛查单位的妇女，其中732人（84%）提供了充分的数据。两个样本中共有306名参加者（包括10名收到假阳性结果的参加者），并在所有情况下提供了充分的信息。主要分析是基于这306名妇女加上100名未参加者。回顾性焦虑的分析利用了较大的样本量的695 attenders.Main结果-平均而言，妇女没有过度焦虑的任何三个点在筛选过程中。在参加者中，筛查前和筛查后的焦虑水平没有差异。焦虑在诊所最低，在基线时最高，但绝对值变化非常小。焦虑并不能预测出勤率：在基线时，出勤者和非出勤者之间的焦虑水平没有差异。正如预期的那样，收到假阳性结果的女性回忆起在收到推荐信后感到极度焦虑，但她们的回顾性焦虑也高于乳腺筛查过程早期阶段的阴性筛查者。他们还报告说，经历了更多的疼痛和不适，在x射线。结论-焦虑似乎不是一个重要的问题，在常规筛查的妇女谁收到一个负面的结果。相对于对乳房检查计划的主要批评，这一发现非常令人放心。因此，除了维持目前的程序，如将等待时间减至最低限度外，似乎没有必要在国家方案中引入减少焦虑的特别干预措施。另一方面，对接受假阳性结果的女性的研究结果表明，在异常乳房X光检查后被召回进行评估的经历有一些方面值得进一步关注。同时，还应研究同时性焦虑和回顾性焦虑之间的关系。
Objective - To investigate whether mammography raises anxiety in routinely screened women who receive a negative result.Design - Prospective design in which women completed questionnaires at three key points in the breast screening process: at baseline (before being sent their invitation for breast screening), at the screening clinic immediately before or after screening, and at follow up, about nine months after baseline. Information was obtained from non-attenders as well as from attenders.Setting - Bromelia District Health Authority, served by the South East London Breast Screening Service.Participants - Two overlapping samples were used. Sample A comprised 1500 women aged 50-64 who were due to be called for first round screening at a mobile screening unit. Altogether 1021 (68%) returned a usable questionnaire and 795 of these (78%) also provided adequate information at nine month follow up: there were 695 attenders (including 24 women who received false positive results) and 100 non-attenders. Sample B consisted of 868 women who attended the screening unit in a three month period, 732 (84%) of whom provided adequate data. A total of 306 attenders (including 10 who received false positive results) occurred in both samples and provided adequate information on all occasions. The main analyses were based on these 306 women plus the 100 nonattenders. The analysis of retrospective anxiety took advantage of the larger sample size of 695 attenders.Main results - On average, the women were not unduly anxious at any of the three points in the screening process. Among attenders, there was no difference between anxiety levels immediately before and immediately after screening. Anxiety was lowest at the clinic and highest at baseline but the changes were very small in absolute terms. Anxiety did not predict attendance: there were no differences in anxiety levels between attenders and non-attenders at baseline. As expected, women who received false positive results recalled feeling extremely anxious after they had received the referral letter but their retrospective anxiety was also higher than in the negative screenees at earlier stages in the breast screening process. They also reported having experienced more pain and discomfort during the x ray.Conclusions - Anxiety does not seem to be an important problem in routinely screened women who receive a negative result. This finding is very reassuring in relation to a major criticism of breast screening programmes. Thus, apart from maintaining current procedures such as keeping waiting times to a minimum, there seems to be no need to introduce special anxiety reducing interventions into the national programme. On the other hand, the findings for women who received false positive results suggest that there are aspects of the experience of being recalled for assessment after an abnormal mammogram that warrant further attention. The relationship between contemporaneous and retrospective anxiety should also be studied.