Purpose: Lung cancer is the leading cause of cancer death among both men and women. However, it is still unclear as to whether there are mortality benefits from spiral computed tomography (CT) screening, and little is know about the possible psychological effects of screening. Here, we report the effect of screening outcomes on anxiety levels, fear of cancer, and perceived risk of having lung cancer.

Methods: We recruited 400 individuals who were participating in a CT efficacy study at the University of Pittsburgh to complete written surveys at 4 different times: prior to screening, after screening results were known, and at 6 and 12 months. Among the survey instruments completed by participants were the State-Trait Anxiety Inventory, a Fear of Lung Cancer 3-item instrument, and a question on the perceived risk of lung cancer. The screening outcomes (objective risk of cancer) were negative (<1%), indeterminate (1-5%), and suspicious (15-20%). Mixed model regressions were used to examine changes in survey scores and how these varied among the screening outcome groups.

Results: State anxiety showed a strong concave downward path (i.e., rose then fell) over time for both individuals with indeterminate and suspicious screening results.. However, this trend was only significant for those with indeterminate screens. Current smokers and those with lower education had significantly higher state anxiety. There were no significant changes in trait anxiety for any screening group.

Fear of cancer and perceived risk of cancer also showed a strong and significant concave downward time trend for individuals with a suspicious screening result. The fear of cancer did not diminish for those with a negative screen, although those with a negative screen did have a significant concave upward time path (i.e., fell than rose) for perceived risk of cancer. Women, current smokers, and those with lower education had higher fears of cancer and higher perceived risk.

Conclusions: Lung cancer screening does have negative psychological effects. Even the positive effects of a negative result is not long-lasting, and return to baseline anxiety within a year. Our results point to the need for careful counseling of individuals as they make the decision whether to be screened and after receiving their screening results, particularly for individuals who are current smokers or have a low education level.