Journal of Medical Screening > Volume 16, Number 3 > Pp. 124-130

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Original Articles

The psychological impact of being offered surveillance colonoscopy following attendance at colorectal screening using flexible sigmoidoscopy

Anne Miles  , Senior Research Associate, Psychology, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK

Wendy S Atkin , Professor of Gastrointestinal Epidemiology, Department of Biosurgery & Surgical Technology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK

Ines Kralj-Hans , Research Manager, Colorectal Cancer Screening and Prevention Research Group, Department of Biosurgery & Surgical Technology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK

Jane Wardle , Professor of Clinical Psychology and Director, Cancer Research UK Health Behaviour Research Centre, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK

Correspondence to: Anne Miles, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK; a.miles{at}ucl.ac.uk

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Objectives To examine the psychological impact of being assigned to colonoscopic surveillance following detection of adenomatous polyps at flexible sigmoidoscopy (FS) screening.

Setting Participants invited for screening in 12 of the 14 study centres in the UK FS Trial.

Methods A postal survey following FS screening assessed bowel cancer worry, psychological distress, generalized anxiety, bowel symptoms, general practitioner (GP) visits, positive emotional consequences of screening, and reassurance among people with no polyps (n = 26,573), lower-risk polyps removed at FS (n = 7401) and higher-risk polyps who underwent colonoscopy and were either assigned to colonoscopic surveillance (n = 1543) or discharged (n = 183). A sub-sample (n = 6389) also completed a questionnaire prior to screening attendance that measured bowel cancer worry, generalized anxiety, bowel symptoms and GP visits, making it possible to examine longitudinal changes in this group.

Results People offered surveillance reported lower psychological distress and anxiety than those with either no polyps or lower-risk polyps. The surveillance group also reported more positive emotional benefits of screening than the other outcome groups. Post-screening bowel cancer worry and bowel symptoms were higher in people assigned to surveillance, but both declined over time, reaching levels observed in either one or both of the other two groups found to have polyps, suggesting these results were a consequence of polyp detection rather than surveillance per se. Few differences were observed between the group assigned surveillance and the group discharged following colonoscopy.

Conclusion The results of the current study are broadly reassuring and indicate that referral for colonoscopic surveillance is not associated with adverse psychological consequences.

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