The unintended consequences of cervical screening: distress in women undergoing cytologic surveillance

Linda Sharp (Lead / Corresponding author), Seonaidh Cotton, Margaret Cruickshank, Nicola M. Gray, Kirsten Harrild, Louise Smart, Leslie G. Walker, Julian Little, The TOMBOLA group

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    22 Citations (Scopus)
    229 Downloads (Pure)


    Objective: It is well known that receipt of an initial abnormal cervical cytology test can trigger considerable anxiety among women. Less is known about the impact of follow-up by repeat cytology tests. We quantified prevalence, and identified predictors, of distress after repeat cytologic testing in women with a single low-grade test.

    Methods: Within the framework of the TOMBOLA randomized controlled trial of alternative managements, 844 women aged 20 to 59 years with a single routine cytology test showing borderline nuclear abnormalities (BNA; broadly equivalent to atypical squamous cells of undetermined significance) were assigned to follow-up by repeat cytology in primary care (the first test was due 6 months after the initial BNA result). Women completed sociodemographic and psychosocial questionnaires at recruitment and the Impact of Event Scale (IES) 6 weeks after their first follow-up cytology test. Factors associated with significant psychologic distress (IES ≥ 9) were identified using logistic regression.

    Results: The response rate was 74% (n = 621/844). Of all the respondents, 39% scored in the range for significant distress. Distress varied by follow-up cytology result: negative, 36%; BNA or mild dyskaryosis, 42%; other (including high grade and inadequate), 55%. After adjusting for the cytology result, risk of distress was significantly raised in women who had significant anxiety at recruitment, reported experiencing pain after the follow-up cytology, had children, or were dissatisfied with support they had received after their initial BNA test.

    Conclusions: Substantial proportions of women experience surveillance-related psychologic distress after a follow-up cytology test, even when the result is negative. This is an important, albeit unintended, consequence of cervical screening. Strategies to alleviate this distress merit attention.

    Original languageEnglish
    Pages (from-to)142-150
    Number of pages9
    JournalJournal of Lower Genital Tract Disease
    Issue number2
    Publication statusPublished - Apr 2014


    • Adult
    • Anxiety
    • Cytological Techniques
    • Early Detection of Cancer
    • Female
    • Humans
    • Middle Aged
    • Surveys and Questionnaires
    • Young Adult


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