Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: cross sectional questionnaire study

Maissi, Esther; Marteau, Theresa; Hankins, Matthew; Moss, Sue; Legood, Rosa; Gray, Alastair

doi:10.1136/bmj.328.7451.1293

Cited by 172 publications

(193 citation statements)

References 26 publications

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“…The kind of information that is provided about HPV is likely to affect the impact of testing positive for the virus, although we have identified specific information that appears to be reassuring. Perhaps most important, and consistent with the findings of Maissi et al (2004), is the need for clear and consistent information about HPV to minimise the anxiety associated with uncertainty and confusion. This need is illustrated very clearly by the following quote:…”

Section: Discussionmentioning

confidence: 78%

“…This is the first study to use qualitative methods to gain an indepth understanding of the perceptions of women taking part in HPV testing in the context of cervical cancer screening, rather than questioning women hypothetically (McCaffery et al, 2003;Anhang et al, 2004) or using quantitative methods to measure anxiety (Maissi et al, 2004;McCaffery et al, 2004a). It is considerably strengthened by the inclusion of women from contrasting ethnic and socioeconomic backgrounds.…”

Section: Discussionmentioning

confidence: 99%

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

Waller

McCaffery

Nazroo³

et al. 2005

Br J Cancer

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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 ...

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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

Waller

McCaffery

Nazroo³

et al. 2005

Br J Cancer

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“…Alongside clinical and economic considerations, it has been argued that psychosocial issues also need to be taken into account when deciding whether and how to introduce HPV testing [3,4]. A few studies have indicated that testing positive for HPV may impose a significant psychological burden on the women taking part in screening, over and above the impact of an abnormal smear result [5][6][7]. This seems to be due, at least in part, to the fact that as a sexually transmitted infection (STI), HPV carries connotations of stigma and raises issues for relationships that are not commonly experienced when receiving an abnormal smear result.…”

Section: Introductionmentioning

confidence: 99%

“…Firstly we investigated whether women experience long-term anxiety and distress about being HPV positive while waiting for their second test. On-going anxiety has been found in some women with mildly abnormal cytology who are managed by surveillance [8][9][10] and it is possible that this could be more severe among women who are HPV positive, as the psychosocial burden of testing positive for HPV seems to be greater than the impact of an abnormal smear result [5][6][7]. There is currently no effective means of treating HPV, so women may face on-going positive status without resolution.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2006

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Objective: To evaluate the psychosocial impact of taking part in repeated testing for human papillomavirus (HPV) in the context of cervical cancer screening.Methods: In-depth interviews were carried out with 30 women who were HPV positive with normal cytology at trial baseline, and attended for a repeat HPV test 12 months later. Interview transcripts were analysed qualitatively using Framework Analysis to identify emergent themes.Results: Although women often experienced serious negative emotional consequences at the time of their first positive result, these did not generally last during the year between tests once questions about HPV had been resolved. The emotional impact of testing positive a second time was greater for many women, sometimes causing them to overcome their embarrassment about having a sexually transmitted infection in order to disclose their result and seek support. Among the women interviewed there was an overwhelming preference for immediate colposcopy rather than continued surveillance for persistent HPV. This was associated with the desire for a speedy resolution, and fears about progression to cancer.Conclusions: Although most women did not appear to suffer on-going anxiety while waiting for a second HPV test, this seemed contingent on their information needs being met. Women appeared to be more distressed by a second HPV positive result than a single one, and expressed a clear preference for immediate colposcopy over continued surveillance. This finding might have implications for the way in which HPV testing could be used in cervical cancer screening programmes.

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“…HPV infections can lead to cancers and precancers of the cervix (2), anus, penis, vagina and vulva (3,4), anogenital warts (5,6), and recurrent respiratory papillomatosis (7,8), with growing evidence for a role in the pathogenesis of cancers of the head and neck (9). A diagnosis of HPV can lead to distress (10), shame, and anger and negatively affect sexual activity and enjoyment (11).…”

Section: Introductionmentioning

confidence: 99%

Incidence and Duration of Cervical Human Papillomavirus 6, 11, 16, and 18 Infections in Young Women: An Evaluation from Multiple Analytic Perspectives

Insinga¹,

Dasbach²,

Elbasha³

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Objective: To estimate the incidence and duration of cervical human papillomavirus (HPV)-6, HPV-11, infections in a population of young American women. Methods: The study population consisted of U.S. women who at baseline were 16 to 23 years of age, reported zero to five lifetime sexual partners, never having been pregnant, and never having had a prior abnormal Papanicolaou test and were enrolled in the placebo arm of a randomized multicenter clinical trial of a HPV-16 L1 virus-like particle vaccine. Women underwent type-specific endocervical/ ectocervical swab HPV DNA testing at f6-month intervals for up to 48 months of follow-up. To contribute persontime in the analyses of type-specific HPV incidence, a woman must have had at least three satisfactory swab specimens available and been negative for the relevant HPV type (HPV-6, HPV-11, HPV-16, or HPV-18) on her first two trial swabs. The duration of incident HPV infections was estimated using Kaplan-Meier survival analysis methods.Results: Person-years of exposure ranged by type-specific analysis from 2,645 to 3,188, with an incidence rate per 100 person-years of 3.6 for HPV-6, 0.4 for HPV-11, 5.4 for HPV-16, and 2.1 for HPV-18. With censoring at the time of treatment for cervical intraepithelial neoplasia, where done, the mean duration of incident infections was 9.3, 8.4, 18.2, and 16.4 months, respectively, for HPV-6 (n = 103), HPV-11 (n = 13), HPV-16 (n = 142), and HPV-18 (n = 62). When the duration of HPV infections was truncated at the time of cervical intraepithelial neoplasia detection (any grade), where applicable, mean duration figures were 8.4, 8.1, 14.0, and 15.1 months for HPV-6, HPV-11, HPV-16, and HPV-18 infections, respectively. Conclusions: Previous studies of the mean duration of cervical HPV infection have been based on prevalent infections and/or featured relatively short duration of follow-up. This study tested women for HPV infection over a period of up to 48 months and observed a mean duration of incident HPV-16/ HPV-18 infections approximately twice that of HPV-6/ HPV-11. (Cancer Epidemiol Biomarkers Prev 2007;16(4):709-15)

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Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: cross sectional questionnaire study

Cited by 172 publications

References 26 publications

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

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

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

Incidence and Duration of Cervical Human Papillomavirus 6, 11, 16, and 18 Infections in Young Women: An Evaluation from Multiple Analytic Perspectives

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