title: Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients.
abstract: OBJECTIVE
  Invasive cervical cancer is today the fourth most common cancer of women in western civilization. Screening programs have led to a continuously decrease. Nevertheless, both screening and a positive test result are known to be associated with a negative psychological impact. Screening programs in European countries differ and thus psychological impact might as well. The aim of this study was to evaluate the psychological impact of women with an abnormal Pap smear in a German cohort.
  
  
  METHODS
  Between July 2013 and May 2014, a self-assessment questionnaire was distributed to 595 patients that were referred to a special clinic for cervical dysplasia for further evaluation of an abnormal Pap smear. Patients were recruited in five different centers.
  
  
  RESULTS
  Most patients (45.9 %) were informed about the test result via phone call by their doctor. 68.8 % of the patients felt anxious and 26.3 % even felt panic. After having talked to their physician, 51.4 % of our cohort still felt worried and only 24.4 % felt reassured. Concerning disease management, 48.4 % underwent a control Pap smear in 6 months. The preferred information source was the physician (63.9 %). Compared to the results in other European countries, our study cohort showed differences concerning age distribution, patients living in a partnership, number of children and especially disease management.
  
  
  CONCLUSIONS
  Cancer screening itself and abnormal test results have an impact on patient's feelings. To reduce the psychological impact, patients need to be better informed about the risks and benefits of cancer screening programs and in case of cervical cancer screening about the meaning of an abnormal test result. Our results underline the importance of a trustful physician-patient relationship in that matter.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cologne, Kerpener Straße 34, 50931, Cologne, Germany. Fabinshy.Thangarajah@gmx.de.
authors.forename: Fabinshy
authors.initials: F
authors.lastname: Thangarajah
authors.affiliation: Department of Obstetrics and Gynecology, University of Cologne, Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Einzmann
authors.affiliation: Amedes MVZ for Gynecology and Pathology Munich GmbH, Maximillianstraße 38, 80539, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Bergauer
authors.affiliation: MVZ Institute for Clinical Genetics, Pathology and Cytology Nordrhein GmbH in the Protestant Hospital of Oberhausen, Virchowstraße 20, 46047, Oberhausen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Patzke
authors.affiliation: MVZ Institute for Clinical Genetics, Pathology and Cytology Nordrhein GmbH in the Protestant Hospital of Oberhausen, Virchowstraße 20, 46047, Oberhausen, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Schmidt-Petruschkat
authors.affiliation: Amedes MVZ Wagnerstibbe for Gynecology, Reproductive Medicine, Cytology, Pathology and Internal Medicine, Hannoversche Str. 24, 31848, Bad Muenster, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Theune
authors.affiliation: MVZ Institute for Clinical Genetics, Pathology and Cytology Nordrhein GmbH in the Protestant Hospital of Oberhausen, Virchowstraße 20, 46047, Oberhausen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Engel
authors.affiliation: Department of Obstetrics and Gynecology, University of Cologne, Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Puppe
authors.affiliation: Department of Obstetrics and Gynecology, University of Cologne, Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Richters
authors.affiliation: Department of Obstetrics and Gynecology, University of Cologne, Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mallmann
authors.affiliation: Department of Obstetrics and Gynecology, University of Cologne, Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Kirn
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D055088:Early Detection of Cancer / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D014626:Vaginal Smears / Q000523:psychology*; D055815:Young Adult
keywords: Cervical cancer screening; Pap smear; Psychological impact