A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology

TY - JOUR

T1 - A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology

AU - Cotton, S. C.

AU - Sharp, L.

AU - Little, J.

AU - Gray, N. M.

AU - Walker, L. G.

AU - Whynes, D. K.

AU - Cruickshank, M. E.

AU - The TOMBOLA group

N1 - © 2014 John Wiley & Sons Ltd.

PY - 2015/6

Y1 - 2015/6

N2 - OBJECTIVE: Worldwide, each year, large numbers of women are referred for colposcopy following low-grade abnormal cervical cytology. Many have no visible abnormality on examination. The risk of cervical intra-epithelial neoplasia grade 2/3 (CIN2/3) in these women is low. It is unknown whether, for women, a normal colposcopy resolves the anxiety which often follows the receipt of an abnormal cytology result. We investigated the prevalence of adverse psychological outcomes over 30 months following a normal colposcopy.METHODS: This cohort study was nested within the UK TOMBOLA randomized controlled trial. Women aged 20-59 years, with recent low-grade cytology, who had a satisfactory colposcopy examination and normal transformation zone, completed the Hospital Anxiety and Depression Scale (HADS) and Process Outcome Specific Measure (POSM) at recruitment and during follow-up (12, 18, 24 and 30 months post-recruitment). Outcomes included percentages reporting significant anxiety (HADS anxiety subscale score ≥11), significant depression (HADS depression subscale score ≥8) or worries about the result of the next cytology test, cervical cancer, having sex, future fertility and general health at each time point (point prevalence) and during follow-up (cumulative prevalence).RESULTS: The study included 727 women. All psychological measures (except depression) had high prevalence at recruitment, falling substantially by 12 months. During follow-up, the cumulative prevalence of significant anxiety was 27% and significant depression was 21%. The most frequently reported worry was that the next cytology test would be abnormal (cumulative prevalence of 71%; point prevalence of ≥50% at 12 and 18 months). The cumulative prevalence values of worries about cervical cancer, having sex and future fertility were 33%, 20% and 16%, respectively.CONCLUSIONS: For some women who have low-grade cytology, a normal colposcopy does not appear to provide psychological reassurance.

AB - OBJECTIVE: Worldwide, each year, large numbers of women are referred for colposcopy following low-grade abnormal cervical cytology. Many have no visible abnormality on examination. The risk of cervical intra-epithelial neoplasia grade 2/3 (CIN2/3) in these women is low. It is unknown whether, for women, a normal colposcopy resolves the anxiety which often follows the receipt of an abnormal cytology result. We investigated the prevalence of adverse psychological outcomes over 30 months following a normal colposcopy.METHODS: This cohort study was nested within the UK TOMBOLA randomized controlled trial. Women aged 20-59 years, with recent low-grade cytology, who had a satisfactory colposcopy examination and normal transformation zone, completed the Hospital Anxiety and Depression Scale (HADS) and Process Outcome Specific Measure (POSM) at recruitment and during follow-up (12, 18, 24 and 30 months post-recruitment). Outcomes included percentages reporting significant anxiety (HADS anxiety subscale score ≥11), significant depression (HADS depression subscale score ≥8) or worries about the result of the next cytology test, cervical cancer, having sex, future fertility and general health at each time point (point prevalence) and during follow-up (cumulative prevalence).RESULTS: The study included 727 women. All psychological measures (except depression) had high prevalence at recruitment, falling substantially by 12 months. During follow-up, the cumulative prevalence of significant anxiety was 27% and significant depression was 21%. The most frequently reported worry was that the next cytology test would be abnormal (cumulative prevalence of 71%; point prevalence of ≥50% at 12 and 18 months). The cumulative prevalence values of worries about cervical cancer, having sex and future fertility were 33%, 20% and 16%, respectively.CONCLUSIONS: For some women who have low-grade cytology, a normal colposcopy does not appear to provide psychological reassurance.

UR - http://www.scopus.com/record/display.uri?eid=2-s2.0-84930418405&origin=resultslist&sort=plf-f&src=s&st1=A+normal+colposcopy+examination+fails+to+provide+psychological+reassurance+for+women+who+have+had+low-grade+abnormal+cervical+cytology&st2=dundee&sid=0C2E8C4675C05FA17D0EE3FA4CB887C6.iqs8TDG0Wy6BURhzD3nFA%3a860&sot=b&sdt=b&sl=149&s=TITLE-ABS-KEY%28A+normal+colposcopy+examination+fails+to+provide+psychological+reassurance+for+women+who+have+had+low-grade+abnormal+cervical+cytology%29&relpos=0&citeCnt=1&searchTerm=

U2 - 10.1111/cyt.12173

DO - 10.1111/cyt.12173

M3 - Article

C2 - 25099940

SN - 0956-5507

VL - 26

SP - 178

EP - 187

JO - Cytopathology

JF - Cytopathology

IS - 3

ER -