What women want. Women’s preferences for the management of low‐grade abnormal cervical screening tests: a systematic review

Abstract

Background If human papillomavirus (HPV) testing will replace cytology in primary cervical screening, the frequency of low-grade abnormal screening tests will double. Several available alternatives for the follow-up of low-grade abnormal screening tests have similar outcomes. In this situation, women's preferences have been proposed as a guide for management decisions.Objectives To determine women's preferences for the follow-up of low-grade cervical screening abnormalities.Search strategy Using Medical Subject Headings (MeSH) terms, PubMed was searched for articles published up to December 2010. The reference lists of the retrieved studies were consulted.Selection criteria Studies asking women to state a preference between active follow-up and observation for the management of low-grade abnormalities on screening cytology or HPV tests.Data collection and analysis Information on study design, participants and outcomes was retrieved using a prespecified form. Studies were sorted by design.Main results Thirteen studies were included in the review. In all five studies that surveyed women with abnormal tests before any management had started, two-thirds preferred active follow-up, predominantly as immediate colposcopy, to observation, predominantly as repeated Pap smears. In all but two studies testing other situations, women more often expressed a preference for active follow-up than for observation; however, women appeared to be somewhat more willing to accept observation if reassured of the low risk of cervical cancer.Conclusions Even for low-grade abnormal cervical tests, women tend to prefer active management strategies. It may be a challenge to meet their expectations of optimal follow-up when HPV testing is used in primary screening.

Patient Preferences for Side Effects Associated With Cervical Cancer Treatment

“…Preference studies related to cervical abnormalities largely focus on the management and surveillance of cervical dysplasia (8, 9). Limited research has examined preferences among patients with invasive cervical cancer (10, 11).…”

Women's preferences regarding options for management of atypical, borderline and low‐grade cervical abnormalities

“…Although this statement may be correct based on the studies included in their review, we would like to emphasize that further studies are available that permit us to draw a more generalized conclusion. Based on our systematic review that identified 13 studies published between 1995 and 2010, 2 we observed that women may be more sensitive to whether they are managed immediately or observed for a longer period of time than to whether one or other test is used for their management. The majority of women facing imminent management for their positive screening test, arguably the most relevant situation for determining their preferences, preferred to have their diagnosis determined as soon as possible.…”

“…The majority of women facing imminent management for their positive screening test, arguably the most relevant situation for determining their preferences, preferred to have their diagnosis determined as soon as possible. This was the case whether they were offered colposcopy (three studies), human papillomavirus (HPV) triage (one study), or even repeated cytology testing, but at shorter than standard intervals (one study) 2 . A further two studies that asked for women’s preferences after they had been managed for their own abnormality also showed a preference for immediate diagnostics in the form of colposcopy relative to observation with repeated cytology.…”

“…The literature on women’s preferences, reviewed by Sadique & Legood and ourselves, suggests, however, that women prefer to know as soon as possible whether they require treatment. To continue to search for a safe solution that would spare much of the repeated testing, but also avoid unnecessary referral for colposcopy, might therefore be welcomed by many women 2 …”

Reconsidering Primary HPV Testing in Cervical Cancer Screening

“…It is known that treatment is not recommended for CIN 1 (cervical intraepithelial neoplasia grade 1), giving both the high rate of spontaneous regression as well as persistence after treatment [21]. However, even for low-grade abnormal cervical tests, women tend to prefer active management strategies; and it is very difficult to meet their expectations of optimal follow-up when HPV testing is used in primary screening [22].…”