qualitative methods to explore why negative genetic results can fail to reassure. They
interviewed nine people who had received a negative result for familial adenomatous
polyposis (FAP) which is a genetic condition and results in polyps in the bowel which
can become cancerous if not detected and removed by surgery. They argued that
people may not be reassured by a negative result for two reasons. First, they may hold
a belief about the cause of the illness that does not directly map onto the cause being
tested for. In the case of FAP, people described how they believed that it was caused by
genetics but that genetics could change. Therefore although the test indicated that
they did not have the relevant genes this may not be the case in the future. Second,
they may show a lack of faith in the test itself. For FAP, people were sceptical about the
ability of a blood test to inform about a disease which occurred in the bowel.
3 The receipt of a positive result. As expected, the receipt of a positive result can be
associated with a variety of negative emotions ranging from worry to anxiety and
shock. In 1978, Haynes et al. pointed to increased absenteeism following a diagnosis
of hypertension and suggested that the diagnosis may have caused distress. Moreover,
an abnormal cervical smear may generate anxiety, morbidity and even terror
(Campion et al. 1988; Nathoo 1988; Wilkinson et al. 1990). Psychological costs
have also been reported after screening for coronary heart disease (Stoate 1989),
breast cancer (Fallowfield et al. 1990) and genetic diseases (Marteau et al. 1992).
In addition, levels of depression have been found to be higher in those labelled as
hypertensive (Bloom and Monterossa 1981). However, some research suggests that
these psychological changes may only be maintained in the short term (Reelick et al.
1984). This decay in the psychological consequences has been particularly shown
with the termination of pregnancy following the detection of foetal abnormalities
(Black 1989).4 The psychological effects of subsequent interventions. Although screening is
aimed at detecting illness at an asymptomatic stage of development and subsequently
delaying or averting its development, not all individuals identified as being ‘at risk’
receive treatment. In addition, not all of those identified as being ‘at risk’ will develop
the illness. The literature concerning cervical cancer has debated the efficacy of
treating those individuals identified by cervical screening as ‘at risk’ and has
addressed the possible consequence of this treatment. Duncan (1992) produced a
report on NHS guidelines concerning the management of positive cervical smears.
This suggested that all women with more severe cytological abnormalities should be
referred for colposcopy, whilst others with milder abnormalities should be monitored
by repeat cervical smears. Shafi (1994) suggests that it is important to consider the
psychological impact of referral and treatment and that this impact may be greater
than the risk of serious disease. However, Soutter and Fletcher (1994) suggest that
there is evidence of a progression from mild abnormalities to invasive cervical
cancer and that these women should also be directly referred for a colposcopy. This
suggestion has been further supported by the results of a prospective study of 902
women presenting with mild or moderate abnormalities for the first time (Flannelly
et al. 1994). A study carried out in 1993 examined the effects of a diagnosis of
pre-cancerous changes of the cervix on the psychological state of a group of women228 HEALTH PSYCHOLOGY