In plain language
Screening programs catch cancers early, but they can also frighten people. Anal cancer screening is increasingly recommended for high-risk groups — particularly people living with HIV and men who have sex with men — yet very little was known about how the process affects people psychologically. This review asked what the emotional costs of anal cancer screening are, and how screening programs can be designed to minimise them.
The authors systematically searched four research databases and identified seven studies directly examining the psychosocial side of anal cancer screening, integrating these with lessons from the much larger literatures on cervical, prostate and breast cancer screening. They looked at knowledge, willingness to be screened, worry, acceptability of the procedure, and the impact of waiting for and receiving results.
The evidence suggested screening does not cause clinically significant anxiety or depression in most people, but it can increase cancer-specific worry — especially while waiting for results or further investigation. People who were younger, more distressed at the outset, had more HIV or anal symptoms, or received worse results worried most. Knowledge about anal cancer and HPV was generally poor. The paper recommends targeted education campaigns, clearer communication of results, and a stepped care model that matches the level of support to each patient's result and level of worry — including acceptance-based psychological approaches for managing uncertainty.
Key findings
- Across the seven available studies, anal cancer screening showed no significant adverse effect on general mental health (anxiety, depression, stress or quality of life).
- Screening did, however, increase cancer-specific worry for some participants, with the waiting periods for results and for high-resolution anoscopy being the most distressing points.
- Greater worry was predicted by worse anal or HIV symptoms, younger age, higher baseline distress, and worse histology results.
- Knowledge of anal cancer, HPV and anal Pap testing was generally poor, and willingness to screen was low — but higher knowledge, HIV-positive status and free testing all increased willingness.
- Test-specific psychological questionnaires were more sensitive to screening-related distress than general mental health measures, helping explain conflicting findings across studies.
- The authors propose a stepped care model that triages support — from written information through to psychologist referral — based on screening results, level of worry and risk factors.
How to cite
APA
Landstra, J. M. B., Ciarrochi, J., & Deane, F. P. (2012). Psychosocial aspects of anal cancer screening: A review and recommendations. Sexual Health, 9, 620–627. https://doi.org/10.1071/SH11169
BibTeX
@article{landstra2012psychosocial,
author = {Landstra, Jodie M. B. and Ciarrochi, Joseph and Deane, Frank P.},
title = {Psychosocial aspects of anal cancer screening: a review and recommendations},
journal = {Sexual Health},
year = {2012},
volume = {9},
pages = {620--627},
doi = {10.1071/SH11169}
}
Related work
- All publications by Joseph Ciarrochi (searchable, with free PDFs)
- Process-Based Therapy & Idionomic Analysis
Author: Joseph Ciarrochi (ORCID 0000-0003-0471-8100). Free copy hosted with permission for scholarly use. Please cite the published version via the DOI above.