Long-term psychosocial impact of alternative management policies in women with low-grade abnormal cervical cytology referred for colposcopy: a randomised controlled trial

L Sharp, S Cotton, N Gray, M Avis, I Russell, L Walker, N Waugh, D Whynes, C Woolley, Alison Jane Thornton, L Smart, M Cruickshank, J Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

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10 Citations (Scopus)


BACKGROUND: The debate continues regarding the best management for women with low-grade abnormal cervical cytology attending colposcopy. We compared psychosocial outcomes of alternative management policies in these women.

METHODS: In all, 989 women, aged 20-59 years, with low-grade abnormal cytology, were randomised to immediate large loop excision (LLETZ) or two to four targeted punch biopsies taken immediately with recall for LLETZ if these showed cervical intra-epithelial neoplasia 2/3. At 6 weeks after the last procedure, women completed the hospital anxiety and depression scale (HADS) and the impact of event scale (IES). At 12, 18, 24 and 30 months post recruitment, women completed the HADS and process outcome specific measure (POSM). Prevalence of significant depression (>= 8), significant anxiety (>= 11) and distress (>= 9) and median POSM scores were compared between arms. Multivariate odds ratios (ORs) for immediate LLETZ vs biopsy and recall were computed.

RESULTS: Over the entire follow-up, there was no significant difference between arms in cumulative prevalence or risk of significant depression (OR = 0.78, 95% CI 0.52-1.17) or significant anxiety (OR = 0.83, 95% CI 0.57-1.19). At 6 weeks post procedure, distress did not differ significantly between arms. At later time points, 8-11% had significant depression and 14-16% had significant anxiety but with no differences between arms. The POSM scores did not differ between the arms.

CONCLUSIONS: There is no difference in long-or short-term psychosocial outcomes of immediate LLETZ and punch biopsies with selective recall. British Journal of Cancer (2011) 104, 255-264. doi: 10.1038/sj.bjc.6606042 www.bjcancer.com Published online 21 December 2010 (C) 2011 Cancer Research UK

Original languageEnglish
Pages (from-to)255-264
Number of pages10
JournalBritish Journal of Cancer
Issue number2
Early online date21 Dec 2010
Publication statusPublished - 18 Jan 2011


  • anxiety
  • colposcopy
  • depression
  • distress
  • punch biopsies
  • squamous intraepithelial lesions
  • see-and-treat
  • event scale
  • follow-up
  • psychological responses
  • depression scale
  • hospital anxiety
  • borderline
  • smear
  • questionnaire

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