{"entity":{"id":"rejuv-mind-scan-anxiety","kind":"technology","name":"Anxiety around scans, and what the evidence says about how often to scan","aka":[],"tldr":"Anxiety around a scan has been measured in 57 studies using 81 different instruments, which is why reported rates run from 13 to 83 per cent; moderate to severe anxiety was reported by 4 to 28 per cent. Scanning more often does not lengthen life in breast cancer or in one common lymphoma, and in bowel cancer it found more curable recurrences but no fewer deaths.","summary":"The measurement problem comes first, because it explains the range. A scoping review screened 26,693 citations and included 57 studies across mammography, positron emission tomography and computed tomography. Between them they used 81 different measurement tools, most commonly purpose-designed rating scales, the State Trait Anxiety Inventory and the Hospital Anxiety and Depression Scale. Prevalence ranged from 0 to 64 per cent when a threshold was prespecified and from 13 to 83 per cent when any anxiety counted; mean severity scores were low in 54 of the 62 quantitative measurements. Moderate to severe anxiety occurred in 4 to 28 per cent of people in the studies using descriptive measures. Nine of 20 studies that measured before and after the scan found a significant fall afterwards. Higher anxiety went with lower education, smoking, higher levels of pain, a higher perceived risk of cancer, and diagnostic rather than screening scans; it did not track age, gender, ethnicity or marital status. Six of ten intervention studies, using relaxation, distraction, education or psychological support, reduced it.\n\nThe second half of this record is the question people ask next: if scans are frightening, is the schedule worth it? The answer differs by cancer, and in three well-studied settings the honest answer is that more imaging has not lengthened life.\n\nBowel cancer. The FACS trial randomised 1,202 people in 39 National Health Service hospitals, all of whom had had curative surgery with no evidence of residual disease, to carcinoembryonic antigen blood testing alone, computed tomography alone, both, or minimum follow-up with investigation only if symptoms occurred. After a mean of 4.4 years, recurrence was detected in 199 people (16.6 per cent). Surgical treatment of recurrence with curative intent was achieved in 2.3 per cent of the minimum follow-up group, 6.7 per cent with blood testing, 8.0 per cent with computed tomography and 6.6 per cent with both, so intensive monitoring roughly trebled the chance of an operation aimed at cure. Deaths were 18.2 per cent in the combined intensive groups against 15.9 per cent with minimum follow-up, a difference of 2.3 per cent with a confidence interval from minus 2.6 to plus 7.1, which is to say no significant difference. The authors' conclusion: \"If there is a survival advantage to any strategy, it is likely to be small.\"\n\nBreast cancer. The GIVIO trial randomised 1,320 Italian women under 70 with stage I to III breast cancer to intensive surveillance with bone scan, liver ultrasound, chest radiography and laboratory tests at set intervals, or to the same frequency of physician visits with only clinically indicated tests; both arms had a yearly mammogram. At a median follow-up of 71 months there were 132 deaths (20 per cent) in the intensive group and 122 (18 per cent) in the control group, no difference in time to detection of recurrence, and no difference in any quality-of-life measure at 6, 12, 24 or 60 months, including body image and emotional well-being. The authors wrote that \"Routine use of these tests should be discouraged.\"\n\nLymphoma. The corpus already carries this evidence in detail on the lymphoma follow-up record, built on a prospective cohort in which surveillance imaging found a relapse before any symptoms in 9 of 552 people, and survival after relapse did not differ by whether it was found at a scheduled visit.\n\nWhat a reader can do with this. A sparser schedule is a decision made from trial evidence, not a service being withdrawn, and it is reasonable to ask the team which it is. What those trials do not test is the other half: in all three, the arm with fewer scans still had a route back in. Knowing the number to ring, and what symptoms warrant ringing it, is the part that carries the benefit. Where scan anxiety is severe, the interventions that helped in the scoping review were simple ones, and the record on treating fear of recurrence covers the structured version.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Medical_imaging","links":[{"label":"Scanxiety: a scoping review about scan-associated anxiety (BMJ Open 2021)","url":"https://doi.org/10.1136/bmjopen-2020-043215"},{"label":"Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial (JAMA 2014)","url":"https://doi.org/10.1001/jama.2013.285718"},{"label":"Impact of follow-up testing on survival and health-related quality of life in breast cancer patients: a multicenter randomized controlled trial (JAMA 1994)","url":"https://doi.org/10.1001/jama.1994.03510440047031"},{"label":"Utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma (JCO 2014)","url":"https://doi.org/10.1200/JCO.2014.55.7561"}],"tags":["rejuvenation","survivorship","evidence:moderate","psychosocial"],"related":["lymphoma-living-scanxiety-and-surveillance","idea-late-recurrence-interception"],"cancers":["colorectal","breast-hr-positive","dlbcl","hodgkin-lymphoma","melanoma"],"sections":["rejuvenation","supportive-care","diagnostics"],"technologies":["rejuv-mind-fear-of-recurrence","rejuv-mind-fear-of-recurrence-treatment","survivorship-care-plan","psycho-oncology"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["relapse-recurrence","late-recurrence","biochemical-recurrence","quality-of-life"],"trials":[],"people":[],"bottlenecks":["b-survivorship"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Surveillance imaging after curative treatment can only help if finding a recurrence earlier changes what can be done about it. Where salvage treatment exists and works, as for a solitary liver or lung metastasis from bowel cancer, earlier detection raises the number of people who get it; where relapse is systemic and treatment is the same whenever it starts, earlier detection moves the diagnosis forward without moving the outcome, a pattern known as lead-time bias. The anxiety is a real cost on the other side of that ledger, and the trials that measured quality of life found no compensating gain.","strengths":["Three randomised or prospective datasets with survival and quality-of-life endpoints, not opinion","The drivers of scan anxiety are identified and several are modifiable","Simple interventions reduced it in six of ten studies"],"limitations":["Eighty-one different measurement tools across 57 studies, so prevalence figures are not comparable","The surveillance trials predate modern imaging and circulating tumour DNA testing, which may change the calculus","Nothing here settles the right schedule for cancers with effective salvage treatment"]},"route":"/technologies/rejuv-mind-scan-anxiety/","neighbours":{"term":[{"id":"biochemical-recurrence","kind":"term","name":"Biochemical recurrence (BCR)","route":"/terms/biochemical-recurrence/"},{"id":"late-recurrence","kind":"term","name":"Late recurrence","route":"/terms/late-recurrence/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"},{"id":"relapse-recurrence","kind":"term","name":"Recurrence and relapse","route":"/terms/relapse-recurrence/"},{"id":"lymphoma-living-scanxiety-and-surveillance","kind":"term","name":"The surveillance schedule, and the evidence that routine scans do not find relapse first","route":"/terms/lymphoma-living-scanxiety-and-surveillance/"}],"idea":[{"id":"idea-late-recurrence-interception","kind":"idea","name":"Intercepting late recurrence with ctDNA surveillance and oral SERDs","route":"/ideas/idea-late-recurrence-interception/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"},{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-mind-fear-of-recurrence","kind":"technology","name":"Fear that the cancer will come back: how common it is, and when it stops being ordinary worry","route":"/technologies/rejuv-mind-fear-of-recurrence/"},{"id":"rejuv-measure-fear-of-recurrence-inventory","kind":"technology","name":"Measuring fear of recurrence: the FCRI and its cut-off","route":"/technologies/rejuv-measure-fear-of-recurrence-inventory/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-mind-fear-of-recurrence-treatment","kind":"technology","name":"Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available","route":"/technologies/rejuv-mind-fear-of-recurrence-treatment/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}]}}