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

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.