title: A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology.
abstract: OBJECTIVE
  Worldwide, each year, large numbers of women are referred for colposcopy following low-grade abnormal cervical cytology. Many have no visible abnormality on examination. The risk of cervical intra-epithelial neoplasia grade 2/3 (CIN2/3) in these women is low. It is unknown whether, for women, a normal colposcopy resolves the anxiety which often follows the receipt of an abnormal cytology result. We investigated the prevalence of adverse psychological outcomes over 30 months following a normal colposcopy.
  
  
  METHODS
  This cohort study was nested within the UK TOMBOLA randomized controlled trial. Women aged 20-59 years, with recent low-grade cytology, who had a satisfactory colposcopy examination and normal transformation zone, completed the Hospital Anxiety and Depression Scale (HADS) and Process Outcome Specific Measure (POSM) at recruitment and during follow-up (12, 18, 24 and 30 months post-recruitment). Outcomes included percentages reporting significant anxiety (HADS anxiety subscale score ≥11), significant depression (HADS depression subscale score ≥8) or worries about the result of the next cytology test, cervical cancer, having sex, future fertility and general health at each time point (point prevalence) and during follow-up (cumulative prevalence).
  
  
  RESULTS
  The study included 727 women. All psychological measures (except depression) had high prevalence at recruitment, falling substantially by 12 months. During follow-up, the cumulative prevalence of significant anxiety was 27% and significant depression was 21%. The most frequently reported worry was that the next cytology test would be abnormal (cumulative prevalence of 71%; point prevalence of ≥50% at 12 and 18 months). The cumulative prevalence values of worries about cervical cancer, having sex and future fertility were 33%, 20% and 16%, respectively.
  
  
  CONCLUSIONS
  For some women who have low-grade cytology, a normal colposcopy does not appear to provide psychological reassurance.
authors.affiliation: Obstetrics & Gynaecology, University of Aberdeen, Foresterhill, Aberdeen, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Cotton
authors.affiliation: National Cancer Registry Ireland, Cork, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Sharp
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Little
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Gray
authors.affiliation: University of Hull, Kingston upon Hull, UK.
authors.forename: L G
authors.initials: LG
authors.lastname: Walker
authors.affiliation: School of Economics, University of Nottingham, Nottingham, UK.
authors.forename: D K
authors.initials: DK
authors.lastname: Whynes
authors.affiliation: Obstetrics & Gynaecology, University of Aberdeen, Foresterhill, Aberdeen, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Cruickshank
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy / Q000523:psychology*; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D002578:Uterine Cervical Dysplasia / Q000523:psychology*; D014594:Uterine Neoplasms / Q000175:diagnosis; D055815:Young Adult
keywords: anxiety; cervical screening; colposcopy; cytology; depression; psychological wellbeing