How distressing is referral to colposcopy in cervical cancer screening?: a prospective quality of life study.
OBJECTIVE
Referral for colposcopy because of abnormal Pap test results is likely to be distressing, but the extent and duration of these effects are unknown. We aimed to fill this gap.


METHODS
We conducted a prospective observational study at two departments of Obstetrics and Gynecology (an academic and a non-academic setting). Women referred for colposcopy completed questionnaires before colposcopy, and at 1, 3, and 6 months afterwards. A reference group of 706 screen participants, aged 29-60 years old, was included and completed questionnaires once. Main outcome measures were generic health-related quality of life (HRQoL), assessed through the EQ-5D and the SF-12 physical and mental scores (PCS-12 and MCS-12); anxiety as assessed by STAI-6, and screen-specific anxiety as assessed by the psychological consequences questionnaire (PCQ).


RESULTS
154 women responded to the questionnaire, of whom 132 were included in the analyses. Histological results were CIN 1 in 17/115 women (15%) and CIN 2+ in 62 (54%). In 36 women (31%) there was no histologically confirmed neoplasia. Before colposcopy physical HRQoL scores were similar or slightly better than in the reference group, while mental HRQoL (MSC-12) and (screen-specific) anxiety were worse (p<0.001). Irrespective of CIN-grades, anxiety washed out during follow-up (p<0.001), with changes being clinically relevant.


CONCLUSIONS
Referral for gynecological evaluation because of abnormal PAP-test results was distressing. Anxiety--and not the physical burden of management--seemed to be the most bothersome to women. For all CIN-grades, distress disappeared over six months following colposcopy, suggesting a reassuring effect of gynecological management.
Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: i.korfage@erasmusmc.nl.
Ida J
IJ
Korfage
Dept. of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
Marie-Louise
ML
Essink-Bot
Dept. of Obstetrics and Gynecology, Medical Center Alkmaar, P.O. Box 501, 1800 AM Alkmaar, the Netherlands.
Steven M
SM
Westenberg
Dept. of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
Theo
T
Helmerhorst
Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
J Dik F
JD
Habbema
Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
Marjolein
M
van Ballegooijen
D000328:Adult; D001007:Anxiety / Q000209:etiology*; D015331:Cohort Studies; D003127:Colposcopy / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
Abnormal Pap; CIN; Cervical cancer; Longitudinal; Quality of life; Screening