A large proportion of women who develop cervical cancer in high-income countries such as Germany...
When women receive an abnormal Pap smear test result in the course of their cervical cancer screening, the consequence is often a watchful waiting and monitoring that extends over a long period of time. For many women, this long period of uncertainty means significant psychological distress, which can have an effect on family planning. Some women even develop signs of post-traumatic stress disorder. This is shown by a scientifically based survey, the results of which were recently published in the specialist journal ‘Archives of Gynecology and Obstetrics’ by Springer Medizin Publishing. With a total of 3,753 participants, the study is one of the largest on this topic.
Abnormal findings: many women are concerned about dying of cancer
Although an abnormal Pap test does not provide a reliable indication of cancer, 69.3% of women surveyed were ‘rather’ to ‘severely’ concerned about developing cancer. Nearly 50% of those surveyed stated that they were worried about dying of cervical cancer. A positive HPV test made those affected even more worried: 76% said they were at least ‘rather’ concerned, and 31% even said they were ‘severely’ worried. The figures are remarkable seeing that in most cases an HPV infection heals on its own. Less than one in 100 HPV-infected women actually develops cervical cancer.
Watchful waiting, often for more than a year
Cervical cancer screening programs provide for the taking of another Pap smear or HPV test 3-12-month intervals, depending on the degree of abnormal cells on the Pap smear. This practice is also called watchful waiting. In the survey, 53% of the women stated that they had been waiting for over a year after getting abnormal screening results. More than half of the women had two to five abnormal Pap test results in a row. Watchful waiting can therefore take a very long time, which means that the affected women are exposed to psychological distress over this period.
Abnormal results directly influence family planning
Particularly in women who want to have children, abnormal Pap smear results lead to a significantly higher burden. One in four affected women stated that abnormal results in cervical cancer screening have an influence on family planning. The survey also researched the women’s attitude towards conisation. Regardless of age, women are aware of the increased risk of miscarriage and premature birth after this procedure. Nearly every second woman surveyed is concerned by this risk, either clearly’ or ‘severely’. During conisation, a conical section of suspect tissue is resected from the cervix to remove and examine it.
Abnormal results are a heavy burden on women
About 70% of the women surveyed stated that they were at least ‘rather’ concerned by an abnormal Pap test. 27% even stated they were ‘severely’ worried. This distress can become so severe that signs of post-traumatic stress disorder are sometimes exhibited. All those surveyed who reported abnormalities in their Pap smear were asked to complete the IES-R scale (Impact of Event Scale). This scale is used to determine the degree of distress severity following a traumatic experience. Post-traumatic stress disorder signs were observed in almost one-third of those who filled in the scale.
Statement from Dr Martina Schmitz: health insurance and health policy should take female problems into account
‘The examination methods for the early detection of cervical cancer have their limits. A Pap smear abnormality does not automatically mean cancer, just as a human papillomavirus infection does not automatically mean cancer. This is because both the tissue abnormalities that can be observed in the Pap smear and the HPV infection usually heal on their own. For this reason, doctors wait and see if the finding is still present at the next examination. The now published study confirms the psychological distress that waiting until the next appointment causes in the women affected. Two conclusions can be drawn from this study: (1) much more information is needed about what abnormal results or a positive HPV test really mean; (2) much better, more precise diagnostics is needed in order to prevent this psychological distress from developing in the first place due to unclear findings.
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