Sociodemographic Factors Associated with Psychosocial Consequences of False-Positive Colorectal Cancer Screening: a Prospective Cohort Study

OBJECTIVES:Receiving a false positive in colorectal cancer screening is associated with psychosocial consequences, yet the reasons why some people are more affected than others remain unclear. This study examines the association between sociodemographic factors and psychosocial consequences among screening participants with false positives in colorectal cancer screening. DESIGN:Prospective cohort study. PARTICIPANTS:1432 screening participants with positive faecal immunochemical test (FIT) screening with a follow-up colonoscopy with either no abnormalities or benign polyps (low or medium-high risk). OUTCOME MEASURES:We measured psychosocial consequences with the Consequences Of Screening - ColoRectal Cancer (COS-CRC) questionnaire, after the positive FIT but before the follow-up colonoscopy and again 1 year later. Sociodemographic factors were obtained from national registers and included sex, age, urbanicity, educational level, occupational status, income, assets, cohabitation status and Charlson Comorbidity Index. Psychosocial consequences were measured before colonoscopy (baseline) and 1 year after, and sociodemographic factors were assessed at baseline. RESULTS:We tested 19×2×3=114 associations between the sociodemographic factors and psychosocial consequences within the three groups of false positives and five associations were significant. We found that for participants with medium- and high-risk polyps, experiencing short-term psychosocial consequences was significantly associated with having a university degree compared with secondary school (OR=5.04 (1.38; 18.37), p=0.0142) and being unemployed compared with being employed (OR=5.61 (1.42; 22.14), p=0.0139). For participants with low-risk polyps, long-term consequences were significantly associated with the mid-income quartile (OR=2.32 (1.13; 4.76), p=0.0224) and the highest income quartile (OR=5.47 (1.13; 26.48), p=0.0349) compared with the lowest quartile. For participants with no abnormalities, there was an association between short-term psychosocial consequences and having comorbidities compared with none (OR=2.95 (1.13; 7.71), p=0.0277). CONCLUSION:This study found few significant associations between psychosocial consequences and sociodemographic factors and with no apparent pattern in these. This suggests no strong evidence that specific sociodemographic groups should be especially vulnerable to experiencing psychosocial consequences after a false-positive result from colorectal cancer screening. Thus, there is currently weak evidence for identifying screening participants at higher risk for psychosocial consequences and developing targeted interventions to reduce psychosocial consequences.