Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology

a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA)

Linda Sharp*, Seonaidh Cotton, Anne-Elie Carsin, Nicola Gray, Alison Jane Thornton, Margaret Cruickshank, Julian Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures.

Methods: Nine hundred and eighty-nine women aged 20–59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression.

Results: The response rate was 74%. Six weeks after the last procedure, 86 (21%) of 391 women with a normal TZ had significant distress compared with 144 (42%) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer.

Conclusions: Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required. 


Original languageEnglish
Pages (from-to)368-380
Number of pages13
JournalPsycho-Oncology
Volume22
Issue number2
Early online date12 Dec 2011
DOIs
Publication statusPublished - Feb 2013

Keywords

  • impact
  • PAP-smear
  • health
  • colposcopy
  • oncology
  • depression scale
  • breast-cancer
  • event scale
  • cervical screening
  • hospital anxiety
  • intraepithelial neoplasia
  • questionnaire
  • cancer
  • distress
  • psychosocial factors

Cite this

Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology : a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA). / Sharp, Linda; Cotton, Seonaidh; Carsin, Anne-Elie; Gray, Nicola; Thornton, Alison Jane; Cruickshank, Margaret; Little, Julian; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group.

In: Psycho-Oncology, Vol. 22, No. 2, 02.2013, p. 368-380.

Research output: Contribution to journalArticle

Sharp, Linda ; Cotton, Seonaidh ; Carsin, Anne-Elie ; Gray, Nicola ; Thornton, Alison Jane ; Cruickshank, Margaret ; Little, Julian ; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group. / Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology : a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA). In: Psycho-Oncology. 2013 ; Vol. 22, No. 2. pp. 368-380.
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abstract = "Background: Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures.Methods: Nine hundred and eighty-nine women aged 20–59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression.Results: The response rate was 74{\%}. Six weeks after the last procedure, 86 (21{\%}) of 391 women with a normal TZ had significant distress compared with 144 (42{\%}) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer.Conclusions: Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required. ",
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author = "Linda Sharp and Seonaidh Cotton and Anne-Elie Carsin and Nicola Gray and Thornton, {Alison Jane} and Margaret Cruickshank and Julian Little and {The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group}",
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T1 - Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology

T2 - a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA)

AU - Sharp, Linda

AU - Cotton, Seonaidh

AU - Carsin, Anne-Elie

AU - Gray, Nicola

AU - Thornton, Alison Jane

AU - Cruickshank, Margaret

AU - Little, Julian

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

N1 - Copyright © 2011 John Wiley & Sons, Ltd.

PY - 2013/2

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N2 - Background: Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures.Methods: Nine hundred and eighty-nine women aged 20–59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression.Results: The response rate was 74%. Six weeks after the last procedure, 86 (21%) of 391 women with a normal TZ had significant distress compared with 144 (42%) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer.Conclusions: Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required. 

AB - Background: Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures.Methods: Nine hundred and eighty-nine women aged 20–59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression.Results: The response rate was 74%. Six weeks after the last procedure, 86 (21%) of 391 women with a normal TZ had significant distress compared with 144 (42%) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer.Conclusions: Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required. 

KW - impact

KW - PAP-smear

KW - health

KW - colposcopy

KW - oncology

KW - depression scale

KW - breast-cancer

KW - event scale

KW - cervical screening

KW - hospital anxiety

KW - intraepithelial neoplasia

KW - questionnaire

KW - cancer

KW - distress

KW - psychosocial factors

U2 - 10.1002/pon.2097

DO - 10.1002/pon.2097

M3 - Article

VL - 22

SP - 368

EP - 380

JO - Psycho-Oncology

JF - Psycho-Oncology

SN - 1057-9249

IS - 2

ER -