Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis

McBride, Emily; Tatar, Ovidiu; Rosberger, Zeev; Rockliffe, Lauren; Marlow, Laura A.V.; Moss‐Morris, Rona; Kaur, Navdeep; Wade, Kristina; Waller, Jo

doi:10.1080/17437199.2020.1762106

Cited by 44 publications

(67 citation statements)

References 95 publications

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“…Although they require confirmation using quantitative studies, our findings help tease out nuances pertaining to cognitive versus emotional responses to HPV. Longitudinal studies also support this notion given that psychosexual distress remains elevated for up to 12‐month, whereas general anxiety normalises within 3 months, indicating two distinct psychological pathways 4,5 …”

Section: Discussionmentioning

confidence: 86%

“…The sexually transmitted nature of HPV has previously been linked to feelings of stigma, shame, and embarrassment 4,7,13 . To date, most studies have assumed that sexual concerns play a central role in the development of anxiety following an HPV‐positive result.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the low cancer risk associated with testing HPV+/normal cytology, it is increasingly clear that, as a group, these women experience higher short‐term anxiety than those with normal results 3,4 ; as well as elevated psychosexual distress for up to 12 months 4,5 . For most, anxiety remains in the normal range, but nearly a quarter experience clinically significant anxiety for reasons that remain largely unclear 3 .…”

Section: Introductionmentioning

confidence: 99%

“…For most, anxiety remains in the normal range, but nearly a quarter experience clinically significant anxiety for reasons that remain largely unclear 3 . Psychological responses have been well documented in women testing HPV‐positive with abnormal cytology (where cancer risk is greater) but have been less well explored in women testing HPV+/normal at routine screening 4 . Misinterpreting an HPV+/normal result could cause unnecessary anxiety if women overestimate their risk of cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

“…documented in women testing HPV-positive with abnormal cytology (where cancer risk is greater) but have been less well explored in women testing HPVþ/normal at routine screening. 4 Misinterpreting an HPVþ/normal result could cause unnecessary anxiety if women overestimate their risk of cervical cancer. The positive (HPV) and negative (cytology) terminology may also evoke confusion.…”

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confidence: 99%

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Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study

et al. 2020

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Objective To explore reasons for variations in anxiety in women testing positive for human papillomavirus (HPV) with normal cytology at routine HPV primary cervical cancer screening. Methods In‐depth interviews were conducted with 30 women who had tested HPV‐positive with normal cytology, including 15 with low‐to‐normal anxiety and 15 with high anxiety. Data were analysed using Framework Analysis to compare themes between low and high anxiety groups. Results Several HPV‐related themes were shared across anxiety groups, but only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). In comparison to those with low anxiety, women with high anxiety more strongly voiced cognitions about the 12‐month wait for follow‐up screening, relationship infidelity, a lower internal locus of control and HPV‐related symptom attributions. Conclusions Receiving an HPV‐positive with normal cytology result related to various emotional, cognitive, behavioural and physiological responses; some of which were specific to, or more pronounced in, women with high anxiety. If our observations are confirmed in hypothesis‐driven quantitative studies, the identification of distinct themes relevant to women experiencing high anxiety can inform targeted patient communications and HPV primary screening implementation policy.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study

et al. 2020

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Acceleration of cervical cancer diagnosis with human papillomavirus testing below age 30: Observational study

Mathews

Pesola

Castañón

et al. 2021

Intl Journal of Cancer

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Several international cervical screening guidelines advise against using high‐risk human papillomavirus (HR‐HPV) testing in women younger than 30. The rationale for this in young women, lies in the potential for additional detection of both low‐grade and high‐grade cervical intraepithelial neoplasia (CIN) leading to unnecessary treatments without reducing the burden of cervical cancer. We studied 56 544 women screened at 24 to 29 with HR‐HPV testing and 116 858 screened with liquid‐based cytology (LBC) in the English HPV screening pilot. They were compared to 528 460 women screened at the age of 30 to 49. We studied the detection of cervical cancer and CIN2/3 across two consecutive screening rounds 3 years apart. At 24 to 29, a positive HR‐HPV test detected more cases of cervical cancer in the prevalence round than did a positive LBC test (1.36/1000 screened vs 0.82/1000, ORadj: 1.61, 95% CI: 1.18‐2.19). In women with a negative HR‐HPV test, cervical cancer was diagnosed before or at the incidence round in 0.07/1000. After a negative LBC test, cancer detection reached 0.47/1000 and 40% of these cases were diagnosed at FIGO stage IB+. HR‐HPV testing increased the detection of CIN2/3 diagnoses in two consecutive rounds combined by 30% (71.9/1000 vs 55.2/1000). The patterns of detection of cervical cancer and CIN2/3 were almost identical at older ages. These data support using HR‐HPV testing for screening of women younger than 30, which not only accelerates the diagnosis of cervical cancer but leads to a similar relative increase in CIN2/3 diagnosis to that found in women aged 30 to 49.

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Decision‐making in screening positive participants who follow up with colonoscopy in the Dutch colorectal cancer screening programme: A mixed‐method study

et al. 2021

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Objective: To explore worry and decision-making processes used by faecal immunochemical test (FIT)-positive participants in the Dutch national screening programme for colorectal cancer. Methods:A mixed-methods study consisting of 22 semi-structured interviews in FIT-positive participants who underwent the recommended colonoscopy within 4-6 months after the FIT result, followed by a widespread questionnaire in a larger target population (N = 1495). Results:In the interviews, we recognised two different decision-making processes.The first is an affective heuristic decision process where the decision to participate is made instantly and is paired with high-risk perception, worry and (severe) emotional turmoil. The second is a more time-consuming analytical decision process in which participants describe discussing options with others. In the questionnaire, high levels of cancer worry (CWS > 9) were reported by 34% of respondents.Decisional difficulties were reported by 15% of respondents, and 34% of respondents reported discussing the positive FIT result with their GP. Individuals with high levels of cancer worry contacted their GP less often than those with low levels. Conclusions:The Dutch two-step screening programme may result in high levels of cancer worry in a non-cancer population. More research is needed to monitor worry and its role in decision-making in cancer screening, as well as ways to facilitate decision-making for participants.

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Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis

Abstract: Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis, Health Psychology Review,

Cited by 44 publications

References 95 publications

Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study

Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study

Acceleration of cervical cancer diagnosis with human papillomavirus testing below age 30: Observational study

Decision‐making in screening positive participants who follow up with colonoscopy in the Dutch colorectal cancer screening programme: A mixed‐method study

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