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Impact of Abnormal Screening Results
The aim of cervical cancer screening is to identify pre-cancerous changes and intervene in time to stop progression to invasive cervical cancer. Even if screening fails to identify pre-cancerous changes early in their development, repeat screening at regular intervals is still invaluable in identifying early-stage cancers that may yet be successfully treated and cured (Gustafsson et al 1997; Sawaya et al 2003).
Despite the positive societal impact of screening programmes, abnormal cervical screening results can be associated with significant anxiety (Basen-Engquist et al 2003; Lerman et al 1991).
The reporting of false negative results from cervical screening is a potentially dangerous occurrence, as it can allow cervical cancers to develop undetected, particularly if women do not present for regular screening (van der Graaf et al 1987).
Overtreatment is a common drawback of many cervical cancer screening techniques. This phenomenon is most common with VIA, but it also occurs with conventional cervical screening.
Whilst the introduction of screening programmes has a significant beneficial effect on both the incidence and mortality of cervical cancer, false positive screening results can have significant negative impacts on many women, and false negative results are potentially very dangerous, as they can lead to the development of cervical cancer.
Impact of abnormal cervical screening results
The process of cervical screening can be a cause of stress and anxiety to many women, even without an ultimate diagnosis of invasive cervical cancer. Each stage of the process can contribute to this anxiety (Basen-Engquist et al 2003):
- The cervical screening test itself
- The delay between the test and the result
- A positive diagnosis of abnormal cervical cytology
- Delays between receiving a cervical screening result and follow-up diagnostic treatments such as colposcopy
Significant impairments in mood, daily activities, sexual interest and sleep patterns have been described in women who have received a positive cervical screening test result, as well as significant elevations in worries about cancer (Lerman et al 1991).
Whilst healthcare professionals may see the treatment of early cervical dysplasia as routine, this can still be regarded as a ‘cancer scare’, and thus represent a source of major trauma to the affected woman. It is important to note that the majority of women receiving a positive cervical screening result do not go on to develop cervical cancer, therefore the stress and anxiety experienced by these women is often unnecessary but real.
This anxiety can be exacerbated by a lack of understanding of the causes of cervical cancer; one study showed that only 1% of women were aware of the causal link between HPV and cervical cancer (Waller et al 2004), and extra information on the subject can help reassure women and allay their anxieties (Waller et al 2005).