title: The unintended consequences of cervical screening: distress in women undergoing cytologic surveillance.
abstract: 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.
authors.affiliation: 1National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland; 2Obstetrics and Gynaecology and 3Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, Scotland; 4Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland; 5Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, Scotland; 6University of Hull, Hull, England; and 7Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Seonaidh
authors.initials: S
authors.lastname: Cotton
authors.forename: Margaret
authors.initials: M
authors.lastname: Cruickshank
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Gray
authors.forename: Kirsten
authors.initials: K
authors.lastname: Harrild
authors.forename: Louise
authors.initials: L
authors.lastname: Smart
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Walker
authors.forename: Julian
authors.initials: J
authors.lastname: Little
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D003584:Cytological Techniques / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult