Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study.

Emily Mcbride,Selma Stearns,Jo Waller,Laura A V Marlow,Kirsty F Bennett

doi:10.1002/pon.5540

Emily Mcbride, Selma Stearns + Show 3 more

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https://doi.org/10.1002/pon.5540

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Abstract

ObjectiveTo explore reasons for variations in anxiety in women testing positive for human papillomavirus (HPV) with normal cytology at routine HPV primary cervical cancer screening.MethodsIn‐depth interviews were conducted with 30 women who had tested HPV‐positive with normal cytology, including 15 with low‐to‐normal anxiety and 15 with high anxiety. Data were analysed using Framework Analysis to compare themes between low and high anxiety groups.ResultsSeveral HPV‐related themes were shared across anxiety groups, but only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). In comparison to those with low anxiety, women with high anxiety more strongly voiced cognitions about the 12‐month wait for follow‐up screening, relationship infidelity, a lower internal locus of control and HPV‐related symptom attributions.ConclusionsReceiving an HPV‐positive with normal cytology result related to various emotional, cognitive, behavioural and physiological responses; some of which were specific to, or more pronounced in, women with high anxiety. If our observations are confirmed in hypothesis‐driven quantitative studies, the identification of distinct themes relevant to women experiencing high anxiety can inform targeted patient communications and HPV primary screening implementation policy.

Highlights

Human papillomavirus (HPV) is a common sexually transmitted infection (STI), high‐risk types of which are responsible for virtually all cervical cancers
In 2019, the English National Health Service Cervical Screening Programme (NHSCSP) fully implemented routine human papillomavirus (HPV) primary screening, where cervical cell samples are first tested for HPV and cytology is used to triage HPV‐ positive results
Our findings advance the qualitative literature by exploring psychological response to testing HPV positive with normal cytology at routine HPV primary screening and identifying themes which may be specific to women with high anxiety

Summary

Introduction

Human papillomavirus (HPV) is a common sexually transmitted infection (STI), high‐risk types of which are responsible for virtually all cervical cancers. In 2019, the English National Health Service Cervical Screening Programme (NHSCSP) fully implemented routine HPV primary screening, where cervical cell samples are first tested for HPV and cytology (microscopic cell examination) is used to triage HPV‐ positive results. Under HPV primary screening, women can test positive for HPV with normal cytology (HPVþ/normal). Around 270,000 women in England (8.5% of those attending screening) are expected to receive this result each year.[1] Due to the absence of cytological abnormalities, an HPVþ/normal result carries a very low absolute risk of cervical cancer; given that HPV has been detected, relative risk is higher and women are recalled early for repeat screening at 12 months. Most HPV infections clear naturally within 18 months (65%),[2] and women are only referred to colposcopy after they test HPVþ/ normal three consecutive times at 12‐month intervals.[1]

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