Miles Anne, McClements Paula L, Steele Robert J C, Redeker Claudia, Sevdalis Nick, Wardle Jane
Department of Psychological Sciences, Birkbeck, University of London, London, England.
Information Services Division, NHS National Services Scotland, Edinburgh, Scotland.
Cancer Epidemiol Biomarkers Prev. 2015 Jul;24(7):1032-8. doi: 10.1158/1055-9965.EPI-15-0004. Epub 2015 Apr 29.
Screening using fecal occult blood testing (FOBt) reduces colorectal cancer mortality, but the test has low sensitivity. A "missed" cancer may cause psychologic harms in the screened population that partially counteract the benefits of early detection.
Three hundred and eleven people diagnosed with colorectal cancer (i) after a negative FOBt result (interval cancer), (ii) a positive result (screen-detected cancer), or (iii) in regions where screening was not offered, completed questions on quality of life (FACT-C), depression (CES-D), perceived diagnostic delay, and trust in the results of FOBt screening. Fifteen withheld consent to data matching with medical records, leaving a sample size of 296.
Controlling for demographic and clinical variables, patients with an interval cancer reported poorer quality of life (difference in means = 6.16, P = 0.03) and more diagnostic delay (OR, 0.37; P = 0.02) than patients with screen-detected disease, with no differences in depression. No differences were observed between the interval cancer group and the group not offered screening on these measures. Patients with an interval cancer reported the lowest levels of trust in FOBt.
An interval cancer has adverse effects on trust in FOBt, but does not result in worse psychologic outcomes compared with people diagnosed in areas with no screening program. People with an interval cancer report poorer quality of life than people with screen-detected disease.
Improvements in test sensitivity could improve quality of life among people who complete an FOB test over and above any benefits already conferred by earlier detection.
使用粪便潜血试验（FOBt）进行筛查可降低结直肠癌死亡率，但该试验敏感性较低。“漏诊”的癌症可能会对筛查人群造成心理伤害，部分抵消早期检测的益处。
311名被诊断为结直肠癌的患者，（i）在FOBt结果为阴性后（间隔期癌症），（ii）结果为阳性（筛查发现的癌症），或（iii）在未提供筛查的地区，完成了关于生活质量（FACT-C）、抑郁（CES-D）、感知诊断延迟以及对FOBt筛查结果信任度的问卷调查。15人拒绝同意将数据与医疗记录匹配，最终样本量为296。
在控制人口统计学和临床变量后，与筛查发现疾病的患者相比，间隔期癌症患者报告的生活质量较差（均值差异 = 6.16，P = 0.03），诊断延迟更多（比值比，0.37；P = 0.02），抑郁情况无差异。在这些指标上，间隔期癌症组与未接受筛查组之间未观察到差异。间隔期癌症患者对FOBt的信任度最低。
间隔期癌症对FOBt的信任有不利影响，但与未开展筛查项目地区诊断出的患者相比，心理结局并无更差。间隔期癌症患者报告的生活质量比筛查发现疾病的患者差。
提高检测敏感性可改善完成FOB检测人群的生活质量，这超过了早期检测已带来的任何益处。
