Pre- and postmenopausal high-risk women undergoing screening for ovarian cancer: Anxiety, risk perceptions, and quality of life Journal Article

Authors: Hensley, M. L.; Robson, M. E.; Kauff, N. D.; Korytowsky, B.; Castiel, M.; Ostroff, J.; Hurley, K.; Hann, L. E.; Colon, J.; Spriggs, D.
Article Title: Pre- and postmenopausal high-risk women undergoing screening for ovarian cancer: Anxiety, risk perceptions, and quality of life
Abstract: Objective. Recommendations for women at high risk of ovarian cancer include prophylactic salpingo-oophorectomy (PSO) or screening with transvaginal ultrasonography (TVUS) and CA125 levels. The best strategy for improving survival and maintaining quality of life in high-risk women is not known. Premenopausal women may be more reluctant than postmenopausal women to undergo PSO. However, the risk of false-positive screening results may be more likely in premenopausal women, posing potential psychological risk for those enrolled in high-risk ovarian cancer surveillance programs. We sought to determine whether anxiety, depression, perception of ovarian cancer risk, and false-positive test frequency differed between high-risk premenopausal and postmenopausal women initiating ovarian cancer screening. Methods. High-risk women aged ≥30 years enrolling in a TVUS plus CA125 ovarian cancer screening study completed standard QOL (SF-36), cancer-specific anxiety (IES), depression (CES-D), and ovarian cancer risk perception measures. CA125 > 35 and TVUS showing solid or complex cystic ovarian masses were considered abnormal. Abnormal tests were repeated after 4-6 weeks. Persistently abnormal tests prompted a search for malignancy. Tests that normalized on repeat were considered false positive. Results. One hundred forty-seven high-risk women, median age 46 (range, 30-78), 78 premenopausal and 69 postmenopausal, had ≥1 TVUS/CA125/outcome assessment. Premenopausal women were more likely than postmenopausal women to consider themselves at higher risk of ovarian cancer compared with women their age (P < 0.001) and compared with women with similar family histories (P < 0.001). Mean personal perception of lifetime risk of ovarian cancer among premenopausal women was 37% (range, 0-90%) versus 26% (range, 0-60%) among postmenopausal women (P = 0.02). While general QOL and depression scores were similar, 38% of premenopausal women reported high anxiety versus 27% of postmenopausal women (P = 0.03). Thirty percent of women required repeat CA125 or TVUS after first screening; 10.8% of premenopausal women versus 4.6% of postmenopausal women required repeat CA125; and 23.3% of premenopausal and 20.6% of postmenopausal women required repeat TVUS. One postmenopausal woman with persistently rising CA125 >100 had negative mammography, colonoscopy, and dilation and curettage/bilateral salpingo-oophorectomy. All other abnormal tests normalized on repeat. Two premenopausal women withdrew due to anxiety following false-positive CA125 results. Five women (2 premenopausal, 3 postmenopausal) with normal TVUS/CA125 screening tests elected PSO, with benign findings. Conclusion. Premenopausal women perceive their ovarian cancer risk to be higher, report greater ovarian cancer risk-related anxiety, and are more likely to have false-positive screening results than postmenopausal women. Few high-risk women elect PSO in the short term. Knowledge of the frequency of false-positive screening results and psychosocial outcomes is important for high-risk women choosing strategies for managing ovarian cancer risk. © 2003 Elsevier Science (USA). All rights reserved.
Keywords: adult; aged; middle aged; major clinical study; cancer risk; solid tumor; comparative study; laboratory diagnosis; salpingooophorectomy; prospective studies; ovarian neoplasms; quality of life; ovary cancer; cohort studies; risk factors; cancer screening; attitude to health; mass screening; risk assessment; depression; mammography; colonoscopy; family history; outcomes research; anxiety; benign tumor; high risk population; diagnostic test; premenopause; screening test; postmenopause; false positive reactions; lifespan; ovary cyst; humans; human; female; priority journal; article
Journal Title: Gynecologic Oncology
Volume: 89
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2003-06-01
Start Page: 440
End Page: 446
Language: English
DOI: 10.1016/s0090-8258(03)00147-1
PUBMED: 12798709
PROVIDER: scopus
Notes: Export Date: 12 September 2014 -- Source: Scopus
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MSK Authors
  1. Jamie S Ostroff
    210 Ostroff
  2. Mark E Robson
    368 Robson
  3. Mercedes Castiel
    18 Castiel
  4. Noah Kauff
    122 Kauff
  5. Martee L Hensley
    221 Hensley
  6. Karen E Hurley
    45 Hurley
  7. David R Spriggs
    314 Spriggs
  8. Lucy E Hann
    68 Hann