Psychological distress in cervical cancer screening: results from a German online survey

M Jentschke, R Lehmann, N Drews, A Hansel, M Schmitz, P Hillemanns, M Jentschke, R Lehmann, N Drews, A Hansel, M Schmitz, P Hillemanns

Abstract

Purpose: The PODCAD study aimed at assessing the degree of psychological stress that women experience due to notification of an abnormal Papanicolaou (Pap) smear finding or a positive human papillomavirus (HPV) test result.

Methods: We designed a survey to address the question of psychological burden due to abnormal Pap smear results and/or positive HPV tests. In this online campaign approach, we aimed to reach > 2000 women all over Germany irrespective of kind and number of abnormal screening findings. We asked for different kinds of anxiety, distress and uncertainty regarding both, Pap and HPV status.

Results: A total of 3753 women completed the survey at least partially, and almost 2300 fully completed the survey. Of these, more than 50% were affected already since more than 1 year, and almost half of them had experienced at least three Pap smears in follow-up examinations. Almost 70% of the women were afraid of developing cancer. Intriguingly, almost half of the women with abnormal findings were not aware of their stage of the Pap smear. Furthermore, almost 30% of the women displayed signs of a post-traumatic stress disorder.

Conclusion: Abnormal results in cervical cancer screening have an impact on patients' psychology, irrespective of the knowledge and severity of the findings. Better information concerning risks and benefits of cervical cancer screening and about the meaning of the outcome of its procedures are required to decrease this anxiety.

Keywords: Cervical cancer screening; HPV test; Pap smear; Psychological distress.

Conflict of interest statement

MJ and PH declare no conflicts of interest. RL and ND are employees of DontBePatient gGmbH. MS and AH are shareholders and employees of oncgnostics GmbH, a company that aims to commercialize DNA methylation markers.

Figures

Fig. 1
Fig. 1
Anxiety about developing cancer or even dying
Fig. 2
Fig. 2
Anxiety about the abnormal screening findings. Women with abnormal Pap smear findings or positive HPV test results were asked to judge, on a scale from 0 to 5 (1 = not concerned; 2 = slightly concerned; 3 = rather concerned; 4 = clearly concerned; 5 = severely concerned), how much they were concerned about these findings
Fig. 3
Fig. 3
Distress level among women with childbearing preferences is higher than among other women. Average level of concerns of women, with or without childbearing preferences, in different age groups ( 44 years)

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