title: Colposcopists' experiences of HPV Test of Cure for the follow up of cervical intra-epithelial neoplasia.
abstract: OBJECTIVE
  To survey lead colposcopists in England to explore their views on the recently introduced HPV Test of Cure (TOC) following treatment for cervical intra-epithelial neoplasia (CIN) and to determine the extent to which it has impacted their clinical practice and affected their patients.
  
  
  METHODS
  An online survey was sent to lead colposcopists across England. Questions were asked focusing on the clinicians' confidence in the ability of TOC to guide follow up in various clinical scenarios and how the implementation of TOC had changed patient management.
  
  
  RESULTS
  There was a 50% (N=88) response rate. 90% of respondents indicated they were happy with the new procedure. In the follow-up questions, 20% indicated they were uncomfortable with the procedure when it was applied to women who were CIN2+ with incomplete excision at the endocervical margin. Open-ended questions elicited positive aspects of TOC including reduced follow-up, increased reassurance for patients and clinicians and a faster return to the call-recall system. Negative observations included concerns around HPV positive cases, possible false negatives and anxiety in those women who were originally subject to the pre-TOC guidelines and were now returned to call-recall "earlier" than originally indicated to them. 11% of respondents also indicated they work around the new guidelines to some extent.
  
  
  CONCLUSIONS
  Although clinicians are on the whole positive towards the introduction of TOC, concerns were raised which centre primarily around those patients with CIN2+ combined with positive endocervical margins, issues related to HPV positive cases and the possibility of a false negative HPV result. The possibility of patient anxiety due to return to routine screening earlier than originally expected was also identified as a concern.
authors.affiliation: School of Psychology, Keele University, Keele, Staffordshire ST5 5BG, UK. Electronic address: s.m.sherman@keele.ac.uk.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sherman
authors.affiliation: Department of Gynaecological Oncology, University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
authors.forename: Esther L
authors.initials: EL
authors.lastname: Moss
authors.affiliation: Screening QA Service (West Midlands), Public Health England, 5 St Phillip's Place, Birmingham B3 2PW, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Pearmain
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent ST4 6QG, UK.
authors.forename: Charles W E
authors.initials: CW
authors.lastname: Redman
mesh_terms: D052685:Alphapapillomavirus / Q000302:isolation & purification*; D003127:Colposcopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000628:therapy* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000628:therapy* / Q000821:virology
keywords: Cervical screening; HPV; NHSCSP; Test of Cure