title: Psychological effects of diagnosis and treatment of cervical intraepithelial neoplasia: a systematic review.
abstract: BACKGROUND
  Treatment of cervical intraepithelial neoplasia (CIN) is a common minor surgical procedure to prevent uterine cervical cancer. However, news of an abnormality detected at screening for cancer might cause the woman to worry.
  
  
  OBJECTIVE
  To investigate the psychological consequences of CIN diagnosis and treatment in a systematic review.
  
  
  METHODS
  We searched PubMed using Medical Subject Headings (MeSH) terms for articles published from January 1990 to February 2013. We also examined the reference lists of retrieved articles.
  
  
  METHODS
  Quantitative studies measuring psychological outcomes in women with a histological diagnosis or treatment of CIN, and in women having an outcome other than CIN at cervical screening.
  
  
  METHODS
  We abstracted the data using a pre-specified list of study characteristics and measured outcomes. For studies not reporting statistical testing, we estimated the statistical significance of the differences between the compared groups using unpaired t tests.
  
  
  RESULTS
  From 5099 retrieved abstracts, 16 studies were included. Diagnosis and treatment of CIN were associated with worse psychological outcomes than normal cytology test results, but the impact decreased over time. In several but not all studies, CIN appeared to have similar psychological consequences to abnormal smears. No study showed a difference in psychological outcomes between CIN and cervical cancer diagnosis when these were measured some years after diagnosis.
  
  
  CONCLUSIONS
  The studies suggested that CIN diagnosis and treatment have a negative psychological impact. However, this conclusion should be viewed in the context of a paucity of rigorously designed studies.
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: Maria Eiholm
authors.identifier: http://orcid.org/0000-0002-3431-0563
authors.initials: ME
authors.lastname: Frederiksen
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: Sisse
authors.initials: S
authors.lastname: Njor
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D018450:Disease Progression; D055088:Early Detection of Cancer / Q000523:psychology*; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology / Q000523:psychology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000523:psychology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy
keywords: cervical intraepithelial neoplasia; conization; diagnosis; mass screening; psychology