Understanding the role of oncogenic human papillomavirus (HPV) status on adherence behaviors among women with abnormal cervical cytology

Abstract

Background With the introduction of oncogenic Human Papillomavirus (HPV) testing into cervical screening there is a renewed focus on primary prevention among high-risk groups. To date, little is known about the effectiveness of this program, and the extent to which individual-level factors, such as psychosocial health and agency, may play a role. In particular, it is unclear if knowledge of one’s oncogenic HPV status impacts on adherence behaviors amongst women with screening abnormalities. The purpose of this study was to identify if clinical, demographic or psychosocial factors predict non-adherence with recommended colposcopy follow-up. Methods This prospective pilot study included 145 women referred to a large Toronto colposcopy clinic between December, 2013 and September, 2014. Demographic, clinical and psychosocial characteristics were collected at three points in time: (1) at initial colposcopy consultation; (2) 4–6 weeks following initial consultation, and; (3) at time of follow-up appointment (within 12 months of initial consultation). Results Overall, 13% (n = 145) of the women were classified as non-adherent. Older women (OR = 0.73, p < 0.01) and those with higher-grade lesions (OR = 0.10, p < 0.01) were less likely to be non-adherent, whereas current smokers (OR = 22.46, p < 0.01) were more likely to be non-adherent. While not statistically significant, variation in rates of non-adherence amongst the various HPV status groups (untested; 15.3%, HPV positive; 5.3%, HPV negative; 6.7%) warrants further study. Conclusion Findings of this study indicate that younger women, those with higher-grade lesions and current smokers were more likely to be non-adherent to recommended colposcopy follow-up. While HPV status did not reach statistical significance, the direction of this finding suggests that testing for HPV may have a positive reinforcing role on adherence to follow-up. The direction of this finding warrants further study, and potentially a practical clinical goal as HPV testing for women becomes standard of care.

Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study

“…Almost half (48%) of referrals with cytological abnormalities did not attend colposcopy, probably due to the annual screening interval. Congruent to a recent pilot study [ 24 ], a positive hrHPV result significantly increased attendance in our study by three times. We screened participants with HPV testing in addition to cytology, which at the time was not part of routine CCS in Germany.…”

“…However, most lack individual socio-demographic information [ 10 , 13 , 16 , 17 , 20 ], or are based on underserved populations such as migrants [ 13 , 14 ]. The role of HPV status on follow-up attendance was explored only recently in a small pilot study [ 24 ]. Additionally, small qualitative studies have examined reasons for colposcopy non-attendance [ 25 , 26 ].…”

Depression before and after diagnostic procedures among women with abnormal finding of Papanicolaou screening test

“…39,40 The existence of depressive symptoms before, and persistence after diagnostic procedures, makes it necessary to identify the group of women at risk in order to provide adequate information and counseling to reduce psychological distress in women with a positive Papanicolaou smear screening test. [41][42][43] Adequate adherence to diagnostic procedures would help to reduce the percentage of invasive cervical cancer, when survival is significantly lower than in earlier stages of the disease, and reduce treatment costs. This can be achieved by detecting and adequately controlling the predictive factors of depression in women with a positive Pap smear before and after diagnostic procedures, and through targeted and specifically targeted information that will be actively provided to these women.…”

Glycosylation in Cervical Cancer: New Insights and Clinical Implications

“…Cervical cancer is a principal public health problem across the world and is the second leading cause of death among women aged 20 to 39 years. It displays a growing percentage of adenocarcinoma gradually owing to constant universal screening (45,(89)(90)(91)(92). In general, colposcopically guided biopsies of cervical cancer have been the well-established standard for detecting the presence of a pre-cancer or even to make accurate distinctions such as different CIN grades (45).…”