‘Promotion of health inevitably results in the awareness of sickness’ and suggested that
screening results in introspection. Skrabanek (1988) specifically expressed an awareness
of the negative consequences of screening in his statement that ‘the hazards of screening
are undisputed: they include false positives leading to unnecessary investigations
and treatments, with resulting iatrogenic morbidity both physical and psychological’
(Skrabanek 1988: 1156). He was supported by Marteau (1989), who commented that
‘a positive result in any screening test is invariably received with negative feelings’.
The research: the psychological impact of screening
The negative sequelae of screening have been described as ‘the intangible costs’
(Kinlay 1988) but research suggests that they are indeed experienced by the individuals
involved. These psychological sequelae can be a result of the various different stages of
the screening process:
1 The receipt of a screening invitation.
2 The receipt of a negative result.
3 The receipt of a positive result.
4 The effect of any subsequent interventions.
5 The existence of a screening programme.
1 The receipt of a screening invitation. Research indicates that sending out invita-
tions to enter into a screening programme may not only influence an individual’s
behaviour, but also their psychological state. Fallowfield et al. (1990) carried out a
retrospective study of women’s responses to receiving a request to attend a breast
screening session. Their results showed that 55 per cent reported feeling worried
although 93 per cent were pleased. Dean et al. (1984) sent a measure of psycho-
logical morbidity to women awaiting breast screening and then followed them up six
months later. The results showed no significant increases in psychological morbidity.
However, when asked in retrospect 30 per cent said that they had become anxious
after receiving the letter of invitation. Therefore, receiving a screening invitation may
increase anxiety. However, some research suggests that this is not always the case
(Cockburn et al. 1994).
2 The receipt of a negative result. It may be assumed that receiving a negative result
would only decrease an individual’s anxiety. Most research suggests that this is
the case and that a negative result may create a sense of reassurance (Orton et al.
1991) or no change in anxiety (Dean et al. 1984; Sutton et al. 1995). Further,
Sutton (1999) in his review of the literature on receiving a negative result following
breast cancer screening concluded ‘anxiety is not a significant problem among
women who receive a negative screening result’. However, some research points
towards a relationship between a negative result and an increased level of anxiety
(Stoate 1989) or residual levels of anxiety which do not return to baseline (Baillie
et al. 2000). Further, research indicates that even following negative results some
people attend for further tests even though these tests have not been clinically recom-
mended (e.g. Lerman et al. 2000; Michie et al. 2002). Michie et al. (2003) used
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