Randomised trial of prostate cancer screening in The Netherlands: assessment of acceptance and motives for attendance.

OBJECTIVES: To assess motives for attending a randomised population based prostate cancer screening trial, and to assess acceptance of screening and invitation procedures. METHODS: First pilot of the European Randomised Study of Screening for Prostate Cancer (ERSPC; 1992/1993). Men aged 55-75 years, randomly selected from the population register of four city districts of Rotterdam, were invited by a single invitation for screening. Screening consisted of prostate specific antigen prescreening followed by either (1) digital rectal examination, transrectal ultrasound, and, on indication, biopsy, or (2) no additional screening. After screening, or in the case of non-attendance, a questionnaire was sent to a random sample of 600 attenders and 400 non-attenders, with a reminder after three weeks. OUTCOME MEASURES: In both attenders and non-attenders: knowledge of prostate cancer, attitudes towards screening, motives for attending, procedural aspects and sociodemographic characteristics. In attenders, acceptance of screening procedures. RESULTS: The response rate for the questionnaire was 76%: 94% in attenders and 42% in non-attenders. The main reasons for attending were expected personal benefit (76%) and scientific value (39%), and those for not attending were absence of urological complaints (41%) and anticipated pain or discomfort (24%). Uptake of screening was 32%, which increased to a sustained 42% in following years. Attenders, compared with non-attenders, were significantly younger, more often married, better educated, and had higher perceived health status, more knowledge about prostate cancer, and a more positive attitude towards screening. Information materials and invitation procedures were well accepted (high report marks and satisfaction, and 95% would attend for rescreening). A single prostate specific antigen determination was liked less than a combination of all three screening modalities. CONCLUSIONS: (1) The main reasons for attending are personal benefit and science, and those for not attending were absence of urological complaints and anticipated pain or discomfort; (2) knowledge, attitudes, and motives for attending are comparable with other screening programmes; hence, for population based prostate cancer screening, known health promotional aspects should be carefully considered; (3) prostate specific antigen, digital rectal examination and transrectal ultrasound are acceptable to attenders.

Psychological side-effects of the mass screening on cervical cancer.

The results are reported of a study on the psychological side-effects of mass screening for cervical cancer in Rotterdam. The reactions of participants towards a positive smear and towards the treatment which followed the positive smear were analysed. Women who had problems with a positive smear and with a serious disorder which necessitated an operation and hospitalization had problems with the treatment. However, most women who underwent the operation did not have lasting problems of either a psychological or somatic nature. Women who had been treated by their G.P.s or by a gynaecologist in most cases did not have problems with their treatment. The final conclusion was that mass screening for cervical cancer in Rotterdam caused psychological side-effects to occur among women with a positive smear. However, for the majority of women with a positive smear they were not of a lasting or serious nature.