Zhu Juan, Ma Shanrui, Chen Ru, Liu Zhaorui, Liu Zhengkui, Wei Wenqiang
National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China.
Front Psychiatry. 2022 Oct 20;13:933678. doi: 10.3389/fpsyt.2022.933678. eCollection 2022.
The psychological impact of screening is unclear and has been ignored. This study aimed to evaluate the psychological impact of esophageal cancer (EC) screening on anxiety and depression in China.
A multicenter, population-based study in five high-risk regions of EC was conducted from 2019 to 2020. Residents were recruited and underwent endoscopic screening and then were diagnosed with normal, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and EC. Subjects who did not participate in the screening were referred to as the control group. We surveyed their anxiety and depression levels at baseline and after endoscopy and informed them of different pathological results to evaluate the psychological impact of the screening process.
A total of 2,337 subjects completed all surveys in the screening process (normal: 355, esophagitis: 1,713, LGIN: 213, HGIN: 43 and EC: 13), with 63 controls. The levels of anxiety and depression of screeners were significantly higher than those of controls ( < 0.001). The fluctuation of anxiety and depression showed a "V" pattern in the screening process. The prevalence of anxiety symptoms at baseline, after endoscopy and after knowing the pathological results was 5.6, 0.3, and 3.2%, respectively ( < 0.001), and the corresponding prevalence of depression was 3.6, 0.2, and 2.1%, respectively ( < 0.001). With the aggravation of pathological results, the levels of anxiety and depression increased significantly ( < 0.001), especially in patients informed of HGIN (16.3 and 9.3%) and EC (23.1 and 30.8%).
Participation in endoscopic screening may bring short-term adverse psychological effects, especially at baseline and knowing the pathological results. More attention should be given to participants waiting for endoscopic screening. The method of informing the screening results of HGIN and EC should be improved. Further precise screening is needed to concentrate on high-risk groups to reduce the psychological impact of screening.
筛查的心理影响尚不清楚且一直被忽视。本研究旨在评估中国食管癌（EC）筛查对焦虑和抑郁的心理影响。
2019年至2020年在五个EC高风险地区开展了一项基于人群的多中心研究。招募居民并进行内镜筛查，随后被诊断为正常、食管炎、低级别上皮内瘤变（LGIN）、高级别上皮内瘤变（HGIN）和EC。未参与筛查的受试者被作为对照组。我们在基线期和内镜检查后调查了他们的焦虑和抑郁水平，并告知他们不同的病理结果，以评估筛查过程的心理影响。
共有2337名受试者在筛查过程中完成了所有调查（正常：355例，食管炎：1713例，LGIN：213例，HGIN：43例，EC：13例），有63名对照组。筛查者的焦虑和抑郁水平显著高于对照组（<0.001）。焦虑和抑郁的波动在筛查过程中呈“V”形。基线期、内镜检查后和知晓病理结果后的焦虑症状患病率分别为5.6%、0.3%和3.2%（<0.001），相应的抑郁患病率分别为3.6%、0.2%和2.1%（<0.001）。随着病理结果的加重，焦虑和抑郁水平显著升高（<0.001），尤其是被告知HGIN（16.3%和9.3%）和EC（23.1%和30.8%）的患者。
参与内镜筛查可能会带来短期不良心理影响，尤其是在基线期和知晓病理结果时。应更多关注等待内镜筛查的参与者。告知HGIN和EC筛查结果的方式应加以改进。需要进一步进行精准筛查，聚焦高危人群以降低筛查的心理影响。
