Year of Publication

2013

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Public Health

Department

Epidemiology and Biostatistics

First Advisor

Dr. Wayne T. Sanderson

Abstract

Ovarian cancer (OC) is the fifth most common cancer among women and has the highest mortality of any cancer of the female reproductive system. The majority (61%) of OC cases are diagnosed at a distant stage. Because diagnoses occur most commonly at a late-stage and prognosis for advanced disease is poor, research focusing on the development of effective OC screening methods to facilitate early detection in high-risk, asymptomatic women is fundamental in reducing OC-specific mortality. Presently, there is no screening modality proven efficacious in reducing OC-mortality. However, transvaginal ultrasonography (TVS) has shown value in early detection of OC. TVS presents with the possibility of false positive results which occur when a women receives an abnormal TVS screening test result that is deemed benign following repeat testing (about 7% of the time). The purpose of this dissertation was to evaluate the impact of false positive TVS screening test results on a variety of psychological and behavioral outcomes using mixed and trajectory statistical modeling. The three specific aims of this dissertation were to 1) compare psychological and behavioral outcomes between women receiving normal and false positive results, 2) identify characteristics of women receiving false positive results associated with increased OC-specific distress and 3) characterize distress trajectories following receipt of false positive results.

Analyses included a subset of women participating in an experimental study conducted through the University of Kentucky Ovarian Cancer Screening Program. 750 women completed longitudinal assessments: 375 false positive and 375 normal results. Mixed and group-based trajectory modeling were used to evaluate the specific aims.

Results suggest women receiving false positive TVS result experience increased OC-specific distress compared to women receiving normal results. Among those receiving false positives, less education, no history of an abnormal screening test result, less optimism and more social constraint were associated with increased OC-specific distress. Family history was associated with increased distress among women with monitoring informational coping styles. Three distinct trajectories characterize the trajectory of distress over a four-month study period. Although decreasing over time, a notable proportion of women experience sustained high levels of OC-specific distress.

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