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

S. C. Cotton; L. Sharp; J. Little; N. M. Gray; L. G. Walker; D. K. Whynes; M. E. Cruickshank; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

doi:10.1111/cyt.12173

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

S. C. Cotton, L. Sharp, J. Little, N. M. Gray, L. G. Walker, D. K. Whynes, M. E. Cruickshank, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	178-187
Number of pages	10
Journal	Cytopathology
Volume	26
Issue number	3
Early online date	6 Aug 2014
DOIs	https://doi.org/10.1111/cyt.12173
Publication status	Published - Jun 2015

Bibliographical note

Funded by
Medical Research Council. Grant Number: G9700808
NHS

Keywords

Anxiety
Cervical screening
Colposcopy
Cytology
Depression
Psychological wellbeing

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Cotton, S. C., Sharp, L., Little, J., Gray, N. M., Walker, L. G., Whynes, D. K., Cruickshank, M. E., & The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group (2015). A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology. Cytopathology, 26(3), 178-187. https://doi.org/10.1111/cyt.12173

Cotton, SC, Sharp, L, Little, J, Gray, NM, Walker, LG, Whynes, DK, Cruickshank, ME & The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group 2015, 'A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology', Cytopathology, vol. 26, no. 3, pp. 178-187. https://doi.org/10.1111/cyt.12173

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

abstract = "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.",

keywords = "Anxiety, Cervical screening, Colposcopy, Cytology, Depression, Psychological wellbeing",

author = "Cotton, {S. C.} and L. Sharp and J. Little and Gray, {N. M.} and Walker, {L. G.} and Whynes, {D. K.} and Cruickshank, {M. E.} and {The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group}",

note = "Funded by Medical Research Council. Grant Number: G9700808 NHS",

year = "2015",

month = jun,

doi = "10.1111/cyt.12173",

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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 (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

N1 - Funded by Medical Research Council. Grant Number: G9700808 NHS

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.

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KW - Cervical screening

KW - Colposcopy

KW - Cytology

KW - Depression

KW - Psychological wellbeing

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DO - 10.1111/cyt.12173

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AN - SCOPUS:84930418405

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JO - Cytopathology

JF - Cytopathology

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ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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