Abstract
BACKGROUND: The benefits and harms of cancer screening must be balanced for all participant groups, including those who go on to have cancer diagnosed. The psychological impact of having cancer diagnosed through screening, rather than via another route, is currently unclear. AIMS: We conducted a systematic review to describe the psychological impact of detecting cancer through screening (screen-detected) compared to other routes (non-screen-detected). METHODS: Eligible studies investigated the psychological impact of screen-detected cancer. PubMed, Embase, and PsycINFO were searched. Two reviewers independently screened all titles, abstracts and full texts. We assessed quality using the Mixed Methods Appraisal Tool. Psychological outcome data were extracted for groups with screen-detected and non-screen-detected cancers, calculating Cohen's d where relevant. Results were narratively synthesized. RESULTS: We included 33 papers presenting quantitative results from 31 studies. All were considered medium to high quality. Studies measured psychological outcomes across six cancer screening programmes (breast, prostate, colorectal, lung, cervical and ovarian) using 31 different outcome measures. Receiving a screen-detected cancer diagnosis seemed to be associated with a small or moderate short-term increase in adverse psychological outcomes. In studies comparing outcomes by detection route, most found no difference (n = 16 studies), or that patients with screen-detected cancers fared better than those with non-screen-detected cancers (n = 11 studies), but effect sizes were small. CONCLUSIONS: A screen-detected cancer diagnosis can lead to short-term adverse psychological outcomes; however, there is no strong evidence for a difference in psychological outcomes by detection route. Greater consistency of measures and timepoints would facilitate between-study comparisons. PROSPERO REGISTRATION: PROSPERO 2017 CRD42017075269.