The psychosocial impact of human papillomavirus testing in primary cervical screeninga study within a randomized trial

Abstract

The purpose of the study was to assess the psychosocial impact of human papillomavirus (HPV) testing as an adjunct to cytology in routine primary cervical screening. A controlled study of the psychosocial impact of HPV testing within a randomized trial of HPV testing to assess its efficacy in cervical screening was carried out. The trial provides a randomized setting of revealed HPV results versus concealed results permitting valid comparisons for assessing true psychosocial impact. The setting comprised a large number of general practices in primary care. Women aged 20-64 years who underwent routine cervical screening participated in the study. The intervention was a revealed high-risk HPV test result in addition to cervical cytology. The main outcome was measured using General Health Questionnaire (GHQ-28), Spielberger State-Trait Anxiety Inventory, and Sexual Rating Scale (SRS). Among women with either mildly abnormal or normal cytology, receiving an HPV(+ve) result did not impact significantly on GHQ caseness and mean scores or on Spielberger State and Trait scores when compared with women in whom the HPV(+ve) test result was concealed. Among women with normal cytology, receiving an HPV(+ve) result was associated with a reduction in the Sexual Rating Scale compared with similar women whose HPV(+ve) result was concealed. HPV testing does not add significant psychologic distress when combined with cytology in routine primary cervical screening.

A daunting challenge: Human Papillomavirus assays and cytology in primary cervical screening of women below age 30years

“…This is particularly problematic given that many high-grade CIN detected at young age do not tend to progress to cervical cancer [26,32]. Furthermore, a positive HPV test result induces a psychological burden [33,34], and may reduce sexual satisfaction [35].…”

Screening for prevention and early diagnosis of cancer.

“…With the introduction of HPV testing to cervical screening protocols, qualitative studies have identified concern about acquisition and transmission of a sexually transmitted infection and a need for high-quality information (Hendry et al, 2012). Quantitative findings have been more mixed, with some studies finding adverse psychological outcomes associated with HPV testing (Maissi et al, 2004) and others not (Kitchener et al, 2008;McCaffery et al, 2010). More research is still needed to quantify the associated psychological costs and develop appropriate educational materials to minimize adverse effects.…”

Cervical Cancer: Screening and Therapeutic Perspectives

“…The reason for this lack of difference in detection rate is not obvious at present. HPV testing, reportedly, does not add significant psychological distress when combined with cytology in routine primary cervical screening [39] .…”

“…Persistent genital HPV infection can lead to high-grade CIN (CIN 2-3) and adenocarcinoma in situ, which, left undetected and untreated, can lead to both invasive squamous cell carcinomas and adenocarcinoma. Of the more than 100 HPV types identified, one or more of the 15 so-called high-risk types (HPV 16,18,31,33,35,39,45,51,52,56,58,59,68,73 and 82) are associated with cervical neoplasia [2] . In a pooled analysis of 3,085 cases of cervical cancer in 11 studies from 25 countries, the overall HPV prevalence was 96% where HPV 16 and 18 accounted for 70% and the next six most common types accounted for 19% of cases [10] .…”