Mental health consequences of cervical screening

The effect of ovarian cancer screening on sexual activity and functioning: results from the UK collaborative trial of ovarian cancer screening RCT

Background:

To examine the impact of multimodal (MMS) and ultrasound (USS) screening on the sexual activity and functioning of 22 966 women in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) RCT.

Methods:

Fallowfield's Sexual Activity Questionnaire (FSAQ) was completed prior to randomisation, then annually in a random sample (RS) of women from MMS, USS and control groups. Any women in the study who required repeat screening due to unsatisfactory results formed an Events Sample (ES); they completed questionnaires following an event and annually thereafter.

Results:

Over time in the RS (n=1339) there was no difference between the MMS and USS groups in sexual activity compared with controls. In the ES there were significant differences between the USS group (n=10 156) and the MMS group (n=12 810). The USS group had lower pleasure scores (mean difference=−0.14, P=0.046). For both groups women who had ⩾2 repeat screens, showed a decrease in mean pleasure scores compared with their annual scores (mean difference=−0.16, P=0.005). Similarly mean pleasure scores decreased following more intensive screens compared with annual screening (mean difference=−0.09, P=0.046).

Conclusions:

Ovarian cancer screening did not affect sexual activity and functioning unless a woman had abnormal results and underwent repeated or higher level screening.

Sexual health knowledge of male and female Latino immigrants

To explore sexual health knowledge among Latino immigrants in a Southern U.S. city, we conducted 20 qualitative interviews, (10 Women and 10 Men). We explored knowledge and factors associated with sexual health among male and female Latino immigrants in a Southern U.S. city experiencing a major growth of Latino immigrants in the past 10 years. Both genders demonstrated limited knowledge of Human Papillomavirus (HPV) and risks of sexually transmitted infection (STI) acquisition. Neither gender perceived that they could have an asymptomatic STI, including HPV. Gender differences exist in sexual behaviors and perceptions of STI risk. Females indicated that female Latinas tend to have older sexual initiation age, fewer lifetime sexual partners and more pro-active sexual health than did Latinos when referring to Latino males. Consequently, male and female Latino immigrants could benefit from culturally relevant programs to alleviate STI disparities.

The Psychosocial Burden of HPV

Despite an increased awareness and ‘normalization’ of Human Papillomavirus (HPV) following the release of the HPV vaccine, the psychosocial impact of an HPV infection, the most common sexually transmissible infection (STI), must not be overshadowed. This study employed in-depth interviews ( N = 52) and quantitative surveys ( N = 154) to assess the knowledge, emotional impact and behavioral consequences of an HPV-related diagnosis in women who had received abnormal Pap test results. Findings revealed confusion over test results and themes related to stigma, fear, self-blame, powerlessness and anger emerged. The promotion of the HPV vaccine should not obfuscate the psychosocial burden associated with an HPV diagnosis.

Anticipated shame and worry following an abnormal Pap test result: the impact of information about HPV

OBJECTIVES

To evaluate the impact of HPV and cervical cancer information on women's anticipated feelings of worry and shame if they received an abnormal cervical screening result.

MEASURES

Data were obtained from a British population-based survey of 1081 women aged 25-64 years, carried out in 2006-7. Women were given 'phased' information about HPV and asked whether it would make them feel more or less worried and ashamed if they had an abnormal Pap result.

RESULTS

At baseline, 5.5% women anticipated shame if they had an abnormal Pap test but 88.8% anticipated worry. General and prevalence information about HPV led 4.6% and 5.8% of women to say they would feel more ashamed, while 14.2% said they would feel more ashamed following sexual transmission information. About a third of women also said they would feel more worried having read the information. These responses were more common in women with little education and from non-white ethnic groups.

CONCLUSIONS

HPV information could make women feel more worried about getting an abnormal Pap result, and may make some women feel more ashamed. Worryingly, this may particularly be true for women in groups with low screening uptake rates. Care needs to be taken to ensure HPV information is clear and does not raise unnecessary anxiety.

HPV and cervical cancer testing and prevention: knowledge, beliefs, and attitudes among Hispanic women

Cervical cancer is a preventable disease resulting from infection with high-risk types of sexually transmitted human papillomaviruses (HPVs). Public knowledge of HPVs and their link to cervical cancer is limited. Participation in cervical cancer prevention programs, including Pap and HPV screening and HPV vaccine acceptance, is crucial for limiting the incidence of cervical cancer. Hispanic women suffer the highest cervical cancer incidence rates in the United States. In this study, we conducted community-based focus groups with Hispanic women to explore knowledge and attitudes relating to cervical cancer, HPV, HPV testing, and HPV vaccination. Study findings suggest a need to increase public health literacy in relation to HPV, the link between HPV and cervical cancer, and HPV primary and secondary prevention options. Health care providers should be prepared to share information with patients that supports and promotes informed decision making about HPV testing and vaccines and their complementary roles in cervical cancer screening and prevention.

Human papillomavirus and cervical cancer: issues for biobehavioral and psychosocial research

There is now overwhelming evidence that high-risk, sexually transmitted types of human papillomavirus (HPV) are the main causal agent in cervical cancer. Biobehavioral and psychosocial research is uniquely capable of addressing many of the issues raised by HPV and its link with cervical cancer. In this article we review current findings in this area and identify issues for future research. The first of the three sections explores issues associated with the introduction of HPV testing for the detection and management of cervical abnormalities and the impact of growing public awareness of the sexually transmitted nature of cervical cancer. The implications for public understanding of cervical cancer, psychosocial issues associated with screening, and the potential impact on screening uptake are discussed. The second section addresses the role of biobehavioral factors in the persistence and progression of HPV infection as well as possible interventions to minimize the risk of persistence. Finally, primary prevention of HPV is discussed.