When worry drives behavior

To determine whether worry or FPSE are predictors in the decision to have pBSO, the authors analyzed data from 1,100 high-risk women enrolled in an ovarian cancer screening trial. The participants were categorized into one of two EOC risk groups: (1) having a known germ line mutation in either BRCA1 or BRCA2 or (2) a personal or family history of cancer suggestive of increased genetic risk. The women were screened semiannually with a primary screening of CA125 alone or CA125 and HE4. If the primary screen was positive, women were asked to return for a confirmatory test in which both biomarkers were measured. If either biomarker was positive in the confirmatory test, the participant was asked to undergo a pelvic ultrasound. Women who received two out of three positive test results (among ultrasound, CA125, and HE4) were recommended to undergo a follow-up surgery consult. In addition to the screening tests, all women completed questionnaires at every screening appointment to assess their level of worry about risk for cancer.

The authors analyzed data from 4,700 screening visits. The overall pBSO rate was significantly lower for women with a high-risk pedigree than for those who were known mutation carriers at the time of enrollment. At baseline, 55% of women with a known BRCA1/2 mutation reported moderate/severe worry about cancer risk while approximately 24% of women in the high-risk pedigree group reported that level of worry. The level of moderate/severe worry among women who had never received a FPSE fell from 30% at enrollment to less than 15% by the time of their fifth screening appointment. The authors discovered that the level of worry was indeed a significant predictor of the decision to undergo pBSO. Among women experiencing moderate to severe levels of worry, the rate of pBSO surgery was 1.74 times that in BRCA1/2 carriers and 3.4 times that in women with a high-risk pedigree as compared to women with none to mild worry. When the study looked specifically at women with a FPSE, the authors found similar results. The rate to pBSO was most pronounced in women with a high-risk pedigree, in which the rate to time of surgery in women with at least one FPSE was 2.3 that of those who did not experience FPSE (see figure).

These results clearly reveal the impact that worry and FPSE have on women’s decision to undergo prophylactic surgery. However, these analyses could not determine whether the decision to have pBSO following a FPSE is a direct cause of the FPSE itself or indirectly due to elevated levels of worry. The overall finding from the study was summarized by Dr. Andersen, “the important point about this study for other health psychologists is that this is the first study to find that false-positive screening events, events that can be as small as just being asked to come back and repeat a blood test appear to contribute to women’s decisions to get surgeries.” These new results clearly fill a knowledge gap in the field, “Past studies have shown these events increase levels of worry about cancer risk and may contribute to decisions about screening (e.g. mammography use) but until now we haven’t had data to show they affect bigger decisions like ovarian surgery,” added Dr. Andersen.

The interdisciplinary nature of the study team facilitated the ability to address these questions in greater detail than had previously been possible, a feature that Dr. Andersen emphasized, “I could look at these issues of cancer worry and quality of life in a larger population than prior studies could because I was included as a health psychologist in the big initial developmental work looking for a better screening strategy and people didn’t treat how these women felt about screening and their elevated risk as an afterthought to be dealt with after a team found some screening strategy they thought would work and then started to wonder why there were all these women who don’t participate in screening and get surgeries that aren’t based on the screening programs’ findings or recommendations.”