A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears

Abstract

Objective To determine whether choice of colposcopy or six month cytological surveillance would be beneficial to women with mildly abnormal smears when compared with the national policy of six months surveillance in terms of psychological morbidity. Design A randomised trial based on the Zelen design. Setting A hospital‐based research clinic. Population Four hundred and seventy‐six women who had had a recurrent borderline or mildly dyskaryotic smear on routine cervical screening in primary care. Methods Women were randomised either to six months cytological surveillance or to make a choice between that or colposcopy and were followed up for 1 year. Main outcome measures The primary outcome measure was caseness (score ≥4) on the General Health Questionnaire at 12 months follow up. Other measures were the Spielberger State and Trait scores, default rates and cytology/colposcopy outcomes. Results There was no significant difference between the arms for General Health Questionnaire (GHQ) scores and Spielberger State and Trait at 12 months. There was a significant reduction in psychometric morbidity between baseline and 12 months in both arms. Overall rates of default from the protocol were the same in both arms, but default that led to uncertain ascertainment of cervical pathology was greater in the no‐choice arm. Conclusions This trial indicates that having choice did not impact favourably or harmfully on anxiety or feelings of wellbeing. If a patient is anxious, allowing the patient to choose immediate colposcopy may be preferable because it will improve ascertainment of underlying disease in a group who are more likely to default.

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

“…In contrast to a recent study of patient choice in the management of mild dyskaryosis [12], women with persistent HPV in this qualitative study opted overwhelmingly for an immediate colposcopy rather than a third HPV test in a further 12 months. There is a variety of possible explanations for this.…”

“…In general, women have been found to express a preference for colposcopy over cytological surveillance for the management of mildly abnormal smear results [9,11]. However this was not the case in a recent trial in which women given the option of immediate colposcopy or cytological surveillance were fairly evenly divided in their management choices [12]. We explored the reasons for women's preferences for either immediate colposcopy or repeated HPV testing after 12 months.…”

Understanding Women's Differing Experiences of Distress after Colposcopy: A Qualitative Interview Study

“…Although a few quantitative studies have investigated psychological wellbeing a year or more post-colposcopy (Hellsten et al, 2008;Sharp et al, 2011;Kitchener et al, 2004), substantial gaps remain in the evidence-base surrounding long-term post-colposcopy distress, particularly as regards determinants. In this study worry about future fertility was an important influence on whether women experienced long-term distress; women who had completed their families or did not intend to have children less often had long-term distress.…”

Human papillomavirus triage of women with persistent borderline or mildly dyskaryotic smears: Comparison of costs and side effects of three alternative strategies

“…39,40 and that a higher level of psychological distress in a woman is an important factor contributing to such a choice. 41 It seems then that it is especially the postponement of action in women who know that they tested HPV-positive in strategy C that could negatively affect their well-being, making strategy A more appealing to implement.…”