title: Long-term psychosocial impact of alternative management policies in women with low-grade abnormal cervical cytology referred for colposcopy: a randomised controlled trial.
abstract: 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.
authors.affiliation: National Cancer Registry, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland. linda.sharp@ncri.ie
authors.forename: L
authors.initials: L
authors.lastname: Sharp
authors.forename: S
authors.initials: S
authors.lastname: Cotton
authors.forename: N
authors.initials: N
authors.lastname: Gray
authors.forename: M
authors.initials: M
authors.lastname: Avis
authors.forename: I
authors.initials: I
authors.lastname: Russell
authors.forename: L
authors.initials: L
authors.lastname: Walker
authors.forename: N
authors.initials: N
authors.lastname: Waugh
authors.forename: D
authors.initials: D
authors.lastname: Whynes
authors.forename: C
authors.initials: C
authors.lastname: Woolley
authors.forename: A
authors.initials: A
authors.lastname: Thornton
authors.forename: L
authors.initials: L
authors.lastname: Smart
authors.forename: M
authors.initials: M
authors.lastname: Cruickshank
authors.forename: J
authors.initials: J
authors.lastname: Little
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001706:Biopsy; D003127:Colposcopy; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000523:psychology* / Q000628:therapy