Linda Sharp1, Seonaidh Cotton, Margaret Cruickshank, Nicola M Gray, Kirsten Harrild, Louise Smart, Leslie G Walker, Julian Little. 1. 1National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland; 2Obstetrics and Gynaecology and 3Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, Scotland; 4Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland; 5Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, Scotland; 6University of Hull, Hull, England; and 7Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
OBJECTIVE: It is well known that receipt of an initial abnormal cervical cytology test can trigger considerable anxiety among women. Less is known about the impact of follow-up by repeat cytology tests. We quantified prevalence, and identified predictors, of distress after repeat cytologic testing in women with a single low-grade test. METHODS: Within the framework of the TOMBOLA randomized controlled trial of alternative managements, 844 women aged 20 to 59 years with a single routine cytology test showing borderline nuclear abnormalities (BNA; broadly equivalent to atypical squamous cells of undetermined significance) were assigned to follow-up by repeat cytology in primary care (the first test was due 6 months after the initial BNA result). Women completed sociodemographic and psychosocial questionnaires at recruitment and the Impact of Event Scale (IES) 6 weeks after their first follow-up cytology test. Factors associated with significant psychologic distress (IES ≥ 9) were identified using logistic regression. RESULTS: The response rate was 74% (n = 621/844). Of all the respondents, 39% scored in the range for significant distress. Distress varied by follow-up cytology result: negative, 36%; BNA or mild dyskaryosis, 42%; other (including high grade and inadequate), 55%. After adjusting for the cytology result, risk of distress was significantly raised in women who had significant anxiety at recruitment, reported experiencing pain after the follow-up cytology, had children, or were dissatisfied with support they had received after their initial BNA test. CONCLUSIONS: Substantial proportions of women experience surveillance-related psychologic distress after a follow-up cytology test, even when the result is negative. This is an important, albeit unintended, consequence of cervical screening. Strategies to alleviate this distress merit attention.
RCT Entities:
OBJECTIVE: It is well known that receipt of an initial abnormal cervical cytology test can trigger considerable anxiety among women. Less is known about the impact of follow-up by repeat cytology tests. We quantified prevalence, and identified predictors, of distress after repeat cytologic testing in women with a single low-grade test. METHODS: Within the framework of the TOMBOLA randomized controlled trial of alternative managements, 844 women aged 20 to 59 years with a single routine cytology test showing borderline nuclear abnormalities (BNA; broadly equivalent to atypical squamous cells of undetermined significance) were assigned to follow-up by repeat cytology in primary care (the first test was due 6 months after the initial BNA result). Women completed sociodemographic and psychosocial questionnaires at recruitment and the Impact of Event Scale (IES) 6 weeks after their first follow-up cytology test. Factors associated with significant psychologic distress (IES ≥ 9) were identified using logistic regression. RESULTS: The response rate was 74% (n = 621/844). Of all the respondents, 39% scored in the range for significant distress. Distress varied by follow-up cytology result: negative, 36%; BNA or mild dyskaryosis, 42%; other (including high grade and inadequate), 55%. After adjusting for the cytology result, risk of distress was significantly raised in women who had significant anxiety at recruitment, reported experiencing pain after the follow-up cytology, had children, or were dissatisfied with support they had received after their initial BNA test. CONCLUSIONS: Substantial proportions of women experience surveillance-related psychologic distress after a follow-up cytology test, even when the result is negative. This is an important, albeit unintended, consequence of cervical screening. Strategies to alleviate this distress merit attention.
Authors: Alaina J Brown; Jaimin S Shah; Nicole D Fleming; Alpa M Nick; Pamela T Soliman; Gary B Chisholm; Kathleen M Schmeler; Pedro T Ramirez; Michael Frumovitz Journal: Gynecol Oncol Date: 2016-06-06 Impact factor: 5.482
Authors: Grace Clarke Hillyer; Christopher D Jensen; Wei K Zhao; Alfred I Neugut; Benjamin Lebwohl; Jasmin A Tiro; Lawrence H Kushi; Douglas A Corley Journal: Cancer Date: 2017-06-16 Impact factor: 6.860
Authors: Maria Kyrgiou; Ilkka E J Kalliala; Anita Mitra; Christina Fotopoulou; Sadaf Ghaem-Maghami; Pierre Pl Martin-Hirsch; Margaret Cruickshank; Marc Arbyn; Evangelos Paraskevaidis Journal: Cochrane Database Syst Rev Date: 2017-01-26
Authors: B O'Donovan; Therese Mooney; Ben Rimmer; Patricia Fitzpatrick; Grainne Flannelly; Lorraine Doherty; Noirin Russell; Cara M Martin; John J O'Leary; Linda Sharp; Mairead O'Connor Journal: Prev Med Rep Date: 2021-12-27
Authors: Caroline A Dombrowski; Georgie Mf Weston; Pr Philippe Descamps; Pr Jacques Izopet; Elisabeth J Adams; Elisabeth Adams Journal: Medicine (Baltimore) Date: 2022-07-22 Impact factor: 1.817