Skip Navigation LinksHome > April 2014 - Volume 18 - Issue 2 > The Unintended Consequences of Cervical Screening: Distress...
Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e31829c97d8
Original Articles

The Unintended Consequences of Cervical Screening: Distress in Women Undergoing Cytologic Surveillance

Sharp, Linda PhD1; Cotton, Seonaidh PhD2; Cruickshank, Margaret MD2; Gray, Nicola M. PhD3; Harrild, Kirsten MSc4; Smart, Louise MD5; Walker, Leslie G. PhD6; Little, Julian PhD7; on behalf of the TOMBOLA Group

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Objective: It is well known that receipt of an initial abnormal cervical cytology test can trigger considerable anxiety among women. Less is known about the impact of follow-up by repeat cytology tests. We quantified prevalence, and identified predictors, of distress after repeat cytologic testing in women with a single low-grade test.

Methods: Within the framework of the TOMBOLA randomized controlled trial of alternative managements, 844 women aged 20 to 59 years with a single routine cytology test showing borderline nuclear abnormalities (BNA; broadly equivalent to atypical squamous cells of undetermined significance) were assigned to follow-up by repeat cytology in primary care (the first test was due 6 months after the initial BNA result). Women completed sociodemographic and psychosocial questionnaires at recruitment and the Impact of Event Scale (IES) 6 weeks after their first follow-up cytology test. Factors associated with significant psychologic distress (IES ≥ 9) were identified using logistic regression.

Results: The response rate was 74% (n = 621/844). Of all the respondents, 39% scored in the range for significant distress. Distress varied by follow-up cytology result: negative, 36%; BNA or mild dyskaryosis, 42%; other (including high grade and inadequate), 55%. After adjusting for the cytology result, risk of distress was significantly raised in women who had significant anxiety at recruitment, reported experiencing pain after the follow-up cytology, had children, or were dissatisfied with support they had received after their initial BNA test.

Conclusions: Substantial proportions of women experience surveillance-related psychologic distress after a follow-up cytology test, even when the result is negative. This is an important, albeit unintended, consequence of cervical screening. Strategies to alleviate this distress merit attention.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology


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