Making sense of information about HPV in cervical screening: a qualitative study

Abstract

Introducing human papillomavirus (HPV) testing into cervical cancer screening has the potential to change the way that women understand cervical cancer, the psychological impact of abnormal screening results and the likelihood of future participation in screening. The study used in-depth interviews to examine how women make sense of information about HPV in the context of cervical cancer screening. A total of 74 women were recruited following participation in HPV testing. Women varied widely in their beliefs about the aetiology of cervical cancer and its relationship with sexual activity, as well as in their understanding of the sexually transmitted nature of HPV. While some women who understood that HPV is sexually transmitted were able to integrate this into their existing model of cervical cancer, others were shocked by the link between cervical cancer and sex, of which they had been previously unaware. Women were generally reassured to know that HPV is common, has no symptoms, can lie dormant for many years, can clear up on its own and need not raise concerns about transmission to sexual partners. Women's understanding of HPV varied considerably, even after participation in testing. The way in which information is presented to women will be crucial in minimising the negative psychological impact of testing positive and ensuring that participation in screening remains high. British Journal of Cancer (2005) With the establishment of the role of high-risk types of human papillomavirus (HPV) in the aetiology of the majority of cervical cancers (IARC, 1995; Bosch et al, 2002), there is now widespread support for HPV testing in cervical cancer screening (Solomon et al, 2001;Wright et al, 2002Wright et al, , 2004Cuzick et al, 2003). Human papillomavirus testing is recommended in the US consensus guidelines for triaging women with borderline or mildly abnormal cytology results (Wright et al, 2002), and endorsed by the Food and Drug Administration in primary screening for women aged 30 and over (Food and Drug Administration, 2003). In addition, encouraging research into vaccine development makes immunisation against the virus a realistic possibility in the future (Koutsky et al, 2002).Such major changes to the way that cervical cancer is prevented will inevitably be accompanied by a shift in public understanding of the disease. Linking cervical cancer to a potentially stigmatising sexually transmitted infection (STI) could affect uptake of cervical screening, the impact of abnormal results (McCaffery et al, 2003), informed participation among women taking part in HPV screening (General Medical Council, 1998) and public acceptance of a future vaccination programme (Garland, 2003). At present, very few people in the UK know that cervical cancer is caused by HPV, and a large segment of the population seems unaware of any link between cervical cancer and sexual activity . Studies in other countries have also found low levels of knowledge about HPV (for a review, see Waller et al, 2004a).Aligning public understanding ...

Women's experiences of repeated HPV testing in the context of cervical cancer screening: a qualitative study

“…Anxiety was often compounded by lack of knowledge about HPV. These responses are consistent with results from an earlier study [7,15].…”

Development of an HPV Educational Protocol for Adolescents

“…In preliminary studies of both adults and adolescents, HPV testing has been associated with anxiety, distress, perceived stigma, and fear of further testing and treatment procedures. (13,15,16,25) These types of responses may adversely impact adolescent decisions about future STI screening and follow-up. (26,27) Our previous work has demonstrated that cognitive understanding of HPV infection and Pap tests is a key factor in predicting psychosocial and behavioral responses to HPV infection and abnormal Pap tests.…”

“…(3)(4)(5)(6)(7)(8) Despite its high prevalence and potentially serious consequences, adolescent and young adult women demonstrate poor understanding of HPV and Pap tests. (9)(10)(11)(12)(13)(14) This lack of knowledge may lead to significant psychosocial distress in women diagnosed with HPV or abnormal Pap tests, including fear and anxiety. Research suggests that these types of negative responses could decrease follow-up for diagnostic or treatment procedures.…”

“…Research suggests that these types of negative responses could decrease follow-up for diagnostic or treatment procedures. (13,(15)(16)(17)(18) Education may prevent or alleviate psychosocial distress by addressing women's concerns about HPV. (19) Finally, HPV vaccines have been developed that target the HPV types most commonly associated with cervical cancer, genital warts, or both.…”

Transmission of Human Papillomavirus Without Sexual Contact

“…HPV is known to be highly infectious, but in the majority of cases, the immune system is able to clear the infection or suppress the onset of symptoms. However, the virus may remain dormant in the body for many years (Waller, McCaffery, Nazroo, & Wardle, 2005). In such cases, it is important to help control the spread of the virus.…”