Objective To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics. Design An observational study followed by a randomised trial. Setting Colposcopy Clinic, Royal Free Hospital, London. Participants Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis. Main outcome measure The level of anxiety measured by the Spielberger State Anxiety Inventory. Conclusion Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one‐stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.

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Abstracts: Autumn 2001The following abstracts are taken from journals of interest to our readers and are reviewed by Thomas M. Julian (TMJ), Daron G. Ferris (DGF), and L. Stewart Massad (LSM). The Prognosis in Cervical Epithelial Changes of Uncertain Significance is Similar to that of Cervical Intraepithelial Neoplasia Grade 1 MK Heatley J Clin Pathol 2001;54:474-75Background: The phrase epithelial changes of uncertain significance (ECUS) describes a minor degree of nuclear pleomorphism limited to the basal layers of cervical epithelium in the absence of severe inflammation and with associated normal mitoses, koilocytosis, or koilocytosis associated features. This study investigated the long-term prognosis of this lesion. Methods: Consecutive slides from 128 women with low-grade cervical abnormalities were reviewed. Results: In 43 women, the initial diagnosis of ECUS was confirmed, and the initial diagnosis of cervical intraepithelial neoplasia grade 1 (CIN1) was confirmed in 30 women. Comparison of follow up data from these 73 women revealed a similar prognosis in the two groups in terms of regression to normal, persistence of low-grade disease, or progression to high-grade CIN. Conclusions: Low-grade cervical disease (ECUS and CIN1) should be managed according to similar treatment protocols.Comment: It appears that our British colleagues were not satisfied with ASCUS and AGUS to confuse cytology, and low-grade and high-grade lesions to mix up histology and cytology, but now suggest ECUS as a histologic classification to further cloud the koilocytotic changes and CIN1 diagnoses. The problem with taxonomies is that they are endless and do not always provide better definitions. (TMJ)Objective: To assess the effectiveness of video teaching in reducing the level of anxiety in women attending colposcopy clinics. Design: An observational study followed by a randomized trial was performed in the colposcopy clinic of the Royal Free Hospital, London. Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis had their levels of anxiety measured by the Spielberger State Anxiety Inventory. Conclusion: Women attending colposcopy clinics for either diagnosis or treatment experience a high level of anxiety. The highest levels occur in women attending a one-stop or "see-and-treat" clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety. Comment: It seems logical that the more people know about their health care, the less likely they are to fear it. The unknown is the greatest fear for most people. This study points out that the one-stop or "see-and-treat" approach to the abnormal Pap smear might have psychological drawbacks that we had not previously considered. This questionnaire lacks follow up asking whether the patient was glad to have diagnosis and treatment all accomplished in one visit. I would think that once the process is completed, they might find the approach preferable. (T...

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An organised screening programme has reduced the incidence of cervical cancer in the UK. Cervical screening aims to detect and treat premalignant, low-or high-grade disease. Oncogenic or high-risk human papillomaviruses (HR-HPV) account for over 99.7% of cervical cancer cases; the most common subtypes are 18,31, 33 and 45. HPV vaccination was introduced as part of the childhood vaccination programme in 2008 and will probably save 400 lives per year. HPV testing is useful: in triage of women with borderline or lowgrade cytology; as a test of cure after treatment, in the management of uncertainty, and in primary HPV screening. Learning objectivesTo review the history of cervical screening and colposcopy.To understand the role of HR-HPV in the development of cervical premalignancy and malignancy. To understand the potential of HPV vaccination and the uses of HPV testing in reducing the burden of cervical cancer. Ethical issuesHPV infection is common, so should women with only transient HPV infection be informed of their diagnoses, given that disclosures provide little benefit and may cause significant emotional harm? HPV is related to other premalignant and malignant diseases of the lower genital tract and oropharynx affecting males and females. Should boys therefore be also offered HPV vaccination?