Ellman R, Angeli N, Christians A, Moss S, Chamberlain J, Maguire P
Institute of Cancer Research, Section of Epidemiology, Sutton, Surrey, UK.
Br J Cancer. 1989 Nov;60(5):781-4. doi: 10.1038/bjc.1989.359.
The 28-item GHQ was used to assess psychiatric morbidity in 302 women attending for routine breast cancer screening, 300 women attending for further investigation of a positive screening result and 150 women referred for investigation of breast symptoms. The GHQ-28 was administered on arrival at the relevant clinic and three months later. Medical records were used to determine the outcome of the clinic attendance. Women were classified into routinely screened women, women with false positive screening results, symptomatic women with a benign diagnosis, newly diagnosed cancer patients and previously treated cancer patients. When tested on arrival at the clinic, 25% of routinely screened, 30% of women with false positive results and 35% of symptomatic women with benign conditions were probable cases of psychiatric morbidity. The only statistically significant difference was between the routinely screened and symptomatic benign groups. Levels of anxiety were significantly higher in those with false positive results and in the symptomatic benign group than in the routinely screened. Three months later the prevalence of probable psychiatric morbidity had fallen to 19% in both the routinely screened and those with false positive results but remained significantly higher in the symptomatic benign group (31%). Probable cases of psychiatric morbidity among newly detected cancer patients rose from 34 to 46% over the 3-month period. Among women who had had breast cancer diagnosed in the past prevalence remained at 21%. The prevalence of probable psychiatric morbidity in screened women is similar to that in the general population. Among women referred for further investigation because of a false positive screening result prevalence was only slightly increased and there was no evidence of a sustained increase in anxiety. Provided that delays are kept to a minimum and that women are kept informed, a breast cancer screening programme does not increase psychiatric morbidity. Further research is required in cancer patients to determine whether those diagnosed in asymptomatic women have a higher and more sustained degree of psychiatric morbidity than those diagnosed in women who are aware of symptoms.
采用28项一般健康问卷（GHQ）对302名参加常规乳腺癌筛查的女性、300名因筛查结果呈阳性而接受进一步检查的女性以及150名因乳腺症状而被转诊接受检查的女性的精神疾病发病率进行评估。在她们抵达相关诊所时及三个月后分别进行GHQ - 28问卷调查。通过病历记录来确定就诊结果。这些女性被分为常规筛查女性、筛查结果为假阳性的女性、诊断为良性疾病的有症状女性、新确诊的癌症患者以及既往接受过治疗的癌症患者。在抵达诊所接受检查时，25%的常规筛查女性、30%的筛查结果为假阳性的女性以及35%的诊断为良性疾病的有症状女性可能患有精神疾病。唯一具有统计学显著差异的是常规筛查组和有症状的良性疾病组之间。筛查结果为假阳性的女性以及有症状的良性疾病组的焦虑水平显著高于常规筛查组。三个月后，常规筛查组和筛查结果为假阳性的女性中可能患有精神疾病的比例均降至19%，但有症状的良性疾病组中这一比例仍显著较高（31%）。新确诊的癌症患者中可能患有精神疾病的比例在三个月内从34%升至46%。在过去曾被诊断患有乳腺癌的女性中，这一比例维持在21%。筛查女性中可能患有精神疾病的比例与普通人群相似。因筛查结果为假阳性而被转诊接受进一步检查的女性中，这一比例仅略有升高，且没有证据表明焦虑水平会持续上升。只要将延误时间降至最低并让女性随时了解情况，乳腺癌筛查项目不会增加精神疾病发病率。对于癌症患者还需要进一步研究，以确定在无症状女性中被诊断出癌症的患者是否比那些有症状的女性被诊断出癌症后患有更高且更持续的精神疾病。
