Testing positive for human papillomavirus in routine cervical screening: Examination of psychosocial impact

Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 01/2005; 111(12):1437-43. DOI: 10.1111/j.1471-0528.2004.00279.x
Source: PubMed


To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening.
Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results.
Well women's clinic in London, UK. Population or Sample Four hundred and twenty-eight women aged 20-64 years.
Postal questionnaire survey.
Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships.
Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV-) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV- women with the same smear result [F(1,267) = 8.8, P = 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV- women.
The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.

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Available from: Louise Cadman, Mar 19, 2015
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    • "Fear, anxiety, distress and concern regarding sexual behavior have been reported as the prominent emotional reactions from testing positive for HPV [9-13]. Within relationships, questions about trust and blame may also arise [12]. In addition, women who link their positive HPV test to sexual activity may experience guilt, stigma and shame [14]; however, differences in psychosocial outcomes between HPV and Pap smear testing often converge within 6–12 months (implying that even if differences in anxiety are initially detected, they are unlikely to be long-lasting) [6,8]. "
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    ABSTRACT: Countries must decide whether or not to replace primary cytology-based screening with primary human papillomavirus (HPV)-based screening. We aimed to assess how primary screening for an HPV infection, a sexually transmitted infection (STI), and the type of information included in the invitation letter, will affect screening intention. We randomized a representative sample of Norwegian women to one of three invitation letters: 1) Pap smear, 2) HPV testing or 3) HPV testing with additional information about the nature of the infection. Intention to participate, anxiety level and whether women intend to follow-up abnormal results were measured between groups using chi-squared and nonparametric Kruskal-Wallis tests. Determinants of intention were explored using logistic regression. Responses from 3540 women were representative of the Norwegian population with respect to age, civil status and geographic location. No significant difference across invitation letters was found in women's stated intention to participate (range: 91.8-92.3%), anxiety (39-42% were either quite or very worried) or to follow-up after an abnormal result (range: 97.1-97.6%). Strength of intention to participate was only marginally lower for HPV-based invitation letters, albeit significant (p-value = 0.008), when measured on a scale. Only 36-40% of respondents given the HPV invitations correctly understood that they likely had an STI. We found that switching to primary HPV screening, independent of additional information about HPV infections, is not likely to reduce screening participation rates or increase anxiety; however, women lacked the ability to interpret the meaning of an HPV-test result.
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    • "This concern has been shown to be higher in low education level women and non-white ethnic groups in the UK (32), and more in general, to women’s social status (married vs. unmarried), sexual history (number of partners), cultural background (sexual norms and practices), and knowledge and understanding of the link between HPV and cancer (83). Several studies dealing with this found that current and past relationships, cultural norms concerning sexual habits, and knowledge of HPV and cervical cancer were possible modifiers of the psychological response to a positive result (82). Two studies using focus groups to evaluate the health education material and response letters of a pilot screening program found that the women asked for shorter texts and simpler wording; the greatest concerns were related to the difficulty in understanding the real risk of cancer (36, 87). "
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    ABSTRACT: Background: Screening with HPV is more effective than Pap test in preventing cervical cancer. HPV as primary test will imply longer intervals and a triage test for HPV positive women. It will also permit the development of self-sampling devices. These innovations may affect population coverage, participation, and compliance to protocols, and likely in a different way for less educated, poorer, and disadvantaged women. Aim: To describe the impact on inequalities, actual or presumed, of the introduction of HPV-based screening. Methods: The putative HPV-based screening algorithm has been analyzed to identify critical points for inequalities. A systematic review of the literature has been conducted searching PubMed on HPV screening coverage, participation, and compliance. Results were summarized in a narrative synthesis. Results: Knowledge about HPV and cervical cancer was lower in women with low socio-economic status and in disadvantaged groups. A correct communication can reduce differences. Longer intervals will make it easier to achieve high-population coverage, but higher cost of the test in private providers could reduce the use of opportunistic screening by disadvantaged women. There are some evidences that inviting for HPV test instead of Pap increases participation, but there are no data on social differences. Self-sampling devices are effective in increasing participation and coverage. Some studies showed that the acceptability of self-sampling is higher in more educated women, but there is also an effect on hard-to-reach women. Communication of HPV positivity may increase anxiety and impact on sexual behaviors, the effect is stronger in low educated and disadvantaged women. Finally, many studies found indirect evidence that unvaccinated women are or will be more probably under-screened. Conclusion: The introduction of HPV test may increase population coverage, but non-compliance to protocols and interaction with opportunistic screening can increase the existing inequalities.
    Full-text · Article · Feb 2014 · Frontiers in Oncology
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    • "Some investigators advocate that when post-treatment HR-HPV DNA is absent at 3 to 6 months after conization, especially in patients with a negative cone margin, follow-up can be relaxed, and the patient can resume general population screening [21,26]. Previous research investigating the psychological impact of HPV infection on routine cervical cancer screening found that testing positive for HPV had an adverse psychological impact, with increased anxiety, distress, and concern about sexual relationships [31]. Cervical conization such as LEEP is perceived as distressing and as more painful than a diagnostic colposcopic examination [32]. "
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