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Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening
  1. Valerie Jenkins, DPhil*,
  2. Lesley Fallowfield, DPhil*,
  3. Carolyn Langridge, CChem*,
  4. Jessica Barrett, PhD,
  5. Andy Ryan, PhD,
  6. Ian Jacobs, FRCOG,§,
  7. Justine Kilkerr, BA*,
  8. Usha Menon, FRCOG and
  9. Vernon Farewell, PhD
  1. *Sussex Health Outcomes Research& Education in Cancer (SHORE-C), University of Sussex, Brighton, East Sussex, UK;
  2. Public Health and Primary Care, University of Cambridge, Cambridge, UK;
  3. Women’s Cancer, Institute for Women’s Health, University College London, London, UK;
  4. §Chancellery Building, UNSW, Sydney NSW, Australia; and
  5. MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK.
  1. Address correspondence and reprint requests to Valerie Jenkins, DPhil, SHORE-C, BSMS, University of Sussex, Brighton, BN1 9RX, East Sussex, UK. E-mail:


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.

  • Ovarian cancer
  • Population screening program
  • Withdrawal
  • Anxiety
  • Psychological morbidity

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  • Valerie Jenkins for and on behalf of UKCTOCS Trialists.

  • Declaration of conflicting interests: V.F. and J.B. have support from MRC (U105261167 and G0902100), and U.M. was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. I.J. and U.M. have specified relationships to UCL Business and Abcodia Ltd in the commercial development of sample biobanks; their spouses, partners, or children have no financial relationships relevant to the submitted work. L.J.F., V.J., J.B., V.F., C.L., A.R., and J.K. have no nonfinancial interests that may be relevant to the submitted work.

  • Funding: Supported by Medical Research Council (G9901012) and the Eve Appeal Foundation.

  • Authors’ contributions: L.F., I.J., U.M., and VF devised the psychosocial study. C.L., A.R., and J.K. organized the data for analysis. V.F. and J.B. analyzed the data. V.J., L.J.F., and V.F. wrote the manuscript. I.J. and U.M. contributed to the manuscript. All authors read and commented on the final version. L.J.F. is the guarantor for the psychosocial data.

  • Details of ethics approval: The study was approved by the North West research ethics committee 20th June 2000 (MREC 00/8/34).

  • Trial registration: This study is registered as an International Standard Randomized Controlled Trial, No. ISRCTN22488978.