Hall Rebekah, Spencer Anne E, Lloyd Abigail, Hamilton Willie, Medina-Lara Antonieta
University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
Front Oncol. 2025 Apr 24;15:1467457. doi: 10.3389/fonc.2025.1467457. eCollection 2025.
Routine population-level screening may in the future reduce the high mortality rates associated with late-stage ovarian cancer diagnosis. However, the voluntary nature of screening means that understanding the public's acceptability of the benefits, harms and likely uptake of any potential screening programme is crucial to implementation.
To measure public preferences towards the benefits and harms of a potential screening programme and to predict uptake.
An online Discrete Choice Experiment was completed by 250 women 40-80 years old in England and Wales. Subjects were asked 12 questions where they were asked to choose between two hypothetical screening tests described in terms of four attributes; ovarian cancer deaths, false-positive, false-negative and overdiagnosis rates, and no screening. Responses were analysed using mixed logit regression.
In total, 250 women completed the survey. Ovarian cancer deaths (0.42, [95% CI: 0.40 - 0.44]) was the most important attribute overall, followed by the rate of false positive results (0.30, [95% CI: 0.30-0.30]). However, there were high levels of heterogeneity with individuals exhibiting low levels of worry about ovarian cancer (OR=1.76 [95% CI: 1.17-2.69]), low perceived risk of ovarian cancer (OR=1.44 [95% 1.03-2.03]) or risk-averse individuals (OR=1.46 [95% CI: 1.05-2.04]) significantly more likely to opt for the no screening alternative. Oppositely, individuals who regularly participate in cervical screening (OR=0.63 [0.47-0.90]) were less likely to opt for no screening. Overall, results indicated participants would be willing to accept 2.59 (95% CI: 1.82 - 3.36) false-negative results, 205 (95% CI: 161 - 248) false-positive results and 2.35 (95% CI: 1.76-2.94) per 10,000 people screened to avoid 1 ovarian cancer-related death. Uptake analysis confirmed a high willingness to undergo screening across varying levels of benefits and harms.
Currently ovarian cancer screening is not recommended as available screening methods do not offer benefits in terms of mortality reduction. The results of this study demonstrate a high demand for ovarian cancer screening and a willingness to trade between the benefits and risks of a potential test. Results of this study provide a useful resource for assessing the acceptability of future screening modalities which may become available.
常规的人群层面筛查未来可能会降低与晚期卵巢癌诊断相关的高死亡率。然而，筛查的自愿性质意味着了解公众对任何潜在筛查计划的益处、危害以及可能的接受程度对于实施该计划至关重要。
衡量公众对潜在筛查计划的益处和危害的偏好，并预测接受程度。
250名年龄在40至80岁之间的英格兰和威尔士女性完成了一项在线离散选择实验。受试者被问及12个问题，要求他们在两种假设的筛查测试之间进行选择，这两种测试根据四个属性进行描述；卵巢癌死亡人数、假阳性、假阴性和过度诊断率，以及不进行筛查。使用混合逻辑回归分析回答。
共有250名女性完成了调查。总体而言，卵巢癌死亡人数（0.42，[95%置信区间：0.40 - 0.44]）是最重要的属性，其次是假阳性结果率（0.30，[95%置信区间：0.30 - 0.30]）。然而，存在高度的异质性，对卵巢癌担忧程度低的个体（比值比=1.76 [95%置信区间：1.17 - 2.69]）、认为卵巢癌风险低的个体（比值比=1.44 [95% 1.03 - 2.03]）或风险厌恶型个体（比值比=1.46 [95%置信区间：1.05 - 2.04]）选择不进行筛查的可能性显著更高。相反，定期参加宫颈筛查的个体（比值比=0.63 [0.47 - 0.90]）选择不进行筛查的可能性较小。总体而言，结果表明参与者愿意接受每筛查10000人中有2.59例（95%置信区间：1.82 - 3.36）假阴性结果、205例（95%置信区间：161 - 248）假阳性结果以及2.35例（95%置信区间：1.76 - 2.94），以避免1例与卵巢癌相关的死亡。接受程度分析证实，在不同的益处和危害水平下，人们接受筛查的意愿很高。
目前不建议进行卵巢癌筛查，因为现有的筛查方法在降低死亡率方面没有益处。本研究结果表明对卵巢癌筛查有很高的需求，并且愿意在潜在测试的益处和风险之间进行权衡。本研究结果为评估未来可能出现的筛查方式的可接受性提供了有用的资源。
