Levels of anxiety and distress following receipt of positive screening tests in Australia’s HPV-based cervical screening programme: a cross-sectional survey

Abstract

ObjectiveFrom December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme.MethodsWomen in Australia aged 25–74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress.Results1004 women completed the online survey; 80.9% reported testing HPV negative (HPV−), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV−. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV−. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV−.ConclusionsReceipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.

Dual staining for p16/Ki‐67 to detect high‐grade cervical lesions: Results from the Screening Triage Ascertaining Intraepithelial Neoplasia by Immunostain Testing study

“…Principally, the increased specificity of dual‐stained cytology can lead to increased efficiency of cervical cancer screening by implementing an additional diagnostic tool for triaging management of patients with positive high‐risk HPV, which can reduce colposcopy and histology rates and, consequently, excessive diagnosis. Our results can ultimately guide the implementation of primary HPV screening in Canada, reduce costs and potentially reduce psychological anxiety and distress 37 associated with the diagnosis of a sexually transmitted infection in women not adequately informed about the natural history of HPV.…”

Women’s experiences of the renewed National Cervical Screening Program in Australia 12 months following implementation: a qualitative study

“…9 Previous research has demonstrated a number of negative psychosocial impacts for women testing HPV+ including anxiety and distress, 10 11 feelings of stigma, embarrassment and confusion, as well as concerns about their sexual relationships in terms of trust, fidelity and blame due to concern about the sexually transmitted nature of HPV. 12 Findings from our previous study which surveyed over 1000 women in Australia, also showed women who tested HPV+ were more anxious and distressed than those who tested HPV-, 13 with anxiety scores 10 points higher than those found in a recent English study. 5 As most research to date has been quantitative and conducted prior to implementing the NCSP changes, there is a need for in-depth qualitative exploration of women's views and experiences of the renewed NCSP in the year since its implementation.…”

“…Our own survey data has shown anxiety and distress were higher in women who did not know their results compared with those who were HPV-. 13 The recommendations provided by the women in this sample for information delivery to be staged across the screening journey, from prior to screening to receiving the results, are important to consider when implementing a new screening test to help women’s understanding of both the reasons for the new test and what the results of the new test mean for them. Women have been shown to prefer active or shared decision-making approaches regarding the follow-up of abnormal test results, 22 so it is important women understand what these results mean for them.…”

The effectiveness of HPV16 and HPV18 genotyping and cytology with different thresholds for the triage of human papillomavirus-based screening on self-collected samples

“…In the current study, the prevalence rate of hrHPV was 13.7% on self-collected samples. The high prevalence of hrHPV not only leads to unnecessary colposcopy or follow-up burden [9], but also might add to the mental burden of the HPV-positive women [17]. However, in HPVbased screening programs, there is still no consensus on the optimal management of HPVpositive women to maximize disease detection and minimize colposcopy rates [18,19].…”