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Waller J, Waite F, Marlow L. Awareness and knowledge about HPV and primary HPV screening among women in Great Britain: An online population-based survey. J Med Screen 2024; 31:91-98. [PMID: 37875156 PMCID: PMC11083738 DOI: 10.1177/09691413231205965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Human papillomavirus (HPV) primary testing for cervical screening is being implemented around the world. We explored HPV awareness, and knowledge about primary screening in Great Britain (England, Scotland and Wales), where it has been in place for several years, ahead of extended screening intervals being implemented in England. SETTING/METHODS Women aged 18-70 (n = 1995) were recruited by YouGov from their online panel in August 2022. The weighted sample (n = 1930) was population-representative by age, region, education and social grade. We measured HPV awareness, knowledge (excluding those unaware of HPV) using eight true/false items, and understanding of the role of HPV testing in cervical screening. RESULTS Overall, 77.6% (1499/1930) of women were aware of HPV. When asked to identify the statement describing how cervical screening works, only 12.2% (236/1930) correctly selected the statement reflecting HPV primary screening (13.5% (194/1436) in screening-eligible women). Excluding those unaware of HPV, most participants had heard about the virus in the context of cervical screening (981/1596; 61.5%) or HPV vaccination (1079/1596; 67.6%). Mean knowledge score was 3.7 out of 8 (SD = 2.2) in this group. Most knew that an HPV-positive result does not mean a woman will definitely develop cervical cancer (1091/1499; 72.8%) but far fewer were aware of the long timeline for HPV to develop into cervical cancer (280/1499; 18.7%). CONCLUSIONS Only three-quarters of women in Britain are aware of HPV, and knowledge of primary screening is very low, even among screening-age women. This points to continued need for awareness-raising campaigns to ensure informed choice about screening and mitigate public concern when screening intervals are extended.
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Affiliation(s)
- Jo Waller
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Frances Waite
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Laura Marlow
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
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Bennett KF, Waller J, Bailey JV, Marlow LAV. Exploring the psychosexual impact and disclosure experiences of women testing positive for high-risk cervical human papillomavirus. Br J Health Psychol 2023; 28:62-79. [PMID: 35819012 PMCID: PMC10084302 DOI: 10.1111/bjhp.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine the psychosexual impact and disclosure experiences of women testing HPV-positive following cervical screening. DESIGN In-depth semi-structured interviews. METHODS Interviews were conducted with 21 women of screening age (i.e. those aged 24-65 years) in England who self-reported testing HPV-positive in the context of cervical screening in the last 12 months. Data were analysed using Framework Analysis. RESULTS The sexually transmitted nature of HPV, and aspects relating to the transmission of HPV and where their HPV infection had come from, had an impact on women's current, past and future interpersonal and sexual relationships. Most women had disclosed their HPV infection to others, however the factors influencing their decision, and others' reactions to disclosure differed. The magnitude and extent of psychosexual impact was influenced by how women conceptualized HPV, their understanding of key aspects of the virus, concerns about transmitting HPV and having a persistent HPV infection. CONCLUSIONS Increasing knowledge of key aspects of HPV, such as its high prevalence and spontaneous clearance, and the differences between HPV and other STIs, may increase women's understanding of their screening result and reduce any negative psychosexual consequences of testing HPV-positive. Referring to HPV as an infection that is passed on by skin-to-skin contact during sexual activity, rather than an STI, may help to lessen any psychosexual impact triggered by the STI label.
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Affiliation(s)
- Kirsty F Bennett
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Julia V Bailey
- e-Health Unit, Department of Primary Care and Population Health, University College London, London, UK
| | - Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Rebolj M, Pesola F, Mathews C, Mesher D, Soldan K, Kitchener H. The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot. Br J Cancer 2022; 127:278-287. [PMID: 35347326 PMCID: PMC9296648 DOI: 10.1038/s41416-022-01791-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In England, bivalent vaccination (Cervarix) against high-risk human papillomavirus (HR-HPV) genotypes 16/18 was offered in a population-based catch-up campaign in 2008-2010 to girls aged 14-17 years. These women are now entering the national cervical screening programme. We determined the impact of catch-up bivalent vaccination on their screening outcomes. METHODS We studied the overall and genotype-specific screening outcomes in 108,138 women aged 24-25 (offered vaccination) and 26-29 years (not offered vaccination) included in the English HPV screening pilot between 2013 and 2018. RESULTS At 24-25 years, the detection of high-grade cervical intraepithelial neoplasia (CIN2+) associated with HPV16/18 decreased from 3 to 1% (p < 0.001), with estimated vaccine effectiveness of 87% (95% CI: 82-91%). The detection of any CIN2+ halved from 6 to 3% (p < 0.001), with an estimated vaccine effectiveness of 72% (95% CI: 66-77%). The positive predictive value of a colposcopy for CIN2+ decreased for both low-grade (p < 0.001) and high-grade (p = 0.02) abnormalities on triage cytology. The decreases in screen-detected abnormalities at age 26-29 were of a substantially smaller magnitude. CONCLUSIONS These data confirm high effectiveness of bivalent HPV vaccination delivered through a population-based catch-up campaign in England. These findings add to the rationale for extending screening intervals for vaccinated cohorts.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK.
| | - Francesca Pesola
- Cancer Prevention Trials Unit, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Christopher Mathews
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK
| | - David Mesher
- Blood Safety, Hepatitis, STI and HIV (BSHSH) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Kate Soldan
- Blood Safety, Hepatitis, STI and HIV (BSHSH) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Henry Kitchener
- Division of Cancer Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Rebolj M, Cuschieri K, Mathews CS, Pesola F, Denton K, Kitchener H. Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data. BMJ 2022; 377:e068776. [PMID: 35640960 PMCID: PMC9153243 DOI: 10.1136/bmj-2021-068776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide updated evidence about the risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and cervical cancer after a negative human papillomavirus (HPV) test in primary cervical screening, by age group and test assay. DESIGN Observational study. SETTING Real world data from the English HPV screening pilot's first and second rounds (2013-16, follow-up to end of 2019). PARTICIPANTS 1 341 584 women. INTERVENTIONS Cervical screening with HPV testing or liquid based cytological testing (cytology or smear tests). Women screened with cytology were referred to colposcopy after high grade cytological abnormalities or after borderline or low grade abnormalities combined with a positive HPV triage test. Women screened with HPV testing who were positive were referred at baseline if their cytology triage test showed at least borderline abnormalities or after a retest (early recall) at 12 and 24 months if they had persistent abnormalities. MAIN OUTCOME MEASURES Detection of CIN3+ and cervical cancer after a negative HPV test. RESULTS For women younger than 50 years, second round detection of CIN3+ in this study was significantly lower after a negative HPV screen in the first round than after cytology testing (1.21/1000 v 4.52/1000 women screened, adjusted odds ratio 0.26, 95% confidence interval 0.23 to 0.30), as was the risk of interval cervical cancer (1.31/100 000 v 2.90/100 000 woman years, adjusted hazard ratio 0.44, 0.23 to 0.84). Risk of an incident CIN3+ detected at the second screening round in the pilot five years after a negative HPV test was even lower in women older than 50 years, than in three years in women younger than 50 years (0.57/1000 v 1.21/1000 women screened, adjusted odds ratio 0.46, 0.27 to 0.79). Women with negative HPV tests at early recall after a positive HPV screening test without cytological abnormalities had a higher detection rate of CIN3+ at the second routine recall than women who initially tested HPV negative (5.39/1000 v 1.21/1000 women screened, adjusted odds ratio 3.27, 95% confidence interval 2.21 to 4.84). Detection after a negative result on a clinically validated APTIMA mRNA HPV test was similar to that after clinically validated cobas and RealTime DNA tests (for CIN3+ at the second round 1.32/1000 v 1.14/1000 women screened, adjusted odds ratio 1.05, 0.73 to 1.50). CONCLUSIONS These data support an extension of the screening intervals, regardless of the test assay used: to five years after a negative HPV test in women aged 25-49 years, and even longer for women aged 50 years and older. The screening interval for HPV positive women who have negative HPV tests at early recall should be kept at three years.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
| | - Christopher S Mathews
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Francesca Pesola
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Karin Denton
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Henry Kitchener
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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Chadwick V, Bennett KF, McCaffery KJ, Brotherton JML, Dodd RH. Psychosocial impact of testing HPV positive in Australia’s HPV‐based cervical screening program: a cross‐sectional survey. Psychooncology 2022; 31:1110-1119. [PMID: 35128756 PMCID: PMC9546150 DOI: 10.1002/pon.5897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Objective To examine the impact of self‐reported human papillomavirus (HPV) test result (HPV negative, HPV positive, HPV result unknown) on a range of psychosocial outcomes. Methods Women and other people with a cervix in Australia aged 25–74 years who reported having participated in cervical screening since December 2017 were recruited through Facebook and Instagram to complete an online survey. The primary outcome measures were anxiety, emotional distress, and general distress. Results Nine hundred fifteen participants completed the online survey; 73.2% reported testing HPV negative (‘HPV−’), 15% reported testing HPV positive (‘HPV+’) and 11.8% reported that they did not know/remember their test result (‘HPV unknown’). Compared to participants testing HPV−, participants testing HPV+ had higher mean anxiety (41.67 vs. 37.08, p < 0.001) and emotional distress scores (11.88 vs. 7.71, p < 0.001). Concern about test result (34.3% vs. 1.3%, p < 0.001), perceived risk compared to average women (55.4% vs. 14.1%, p < 0.001), and cancer worry (27.8% vs. 5.9%, p < 0.001) were also greater among HPV+ participants than participants testing HPV−. Participants testing HPV+ felt less reassured about their screening result than participants testing HPV− (16% vs. 75.1%, p < 0.001). Participants testing HPV+ had greater knowledge of HPV (11.96 vs. 10.36 out of 16, p < 0.001) and HPV testing (3.94 vs 3.28 out of 5, p < 0.001) than participants who reported testing HPV−. Conclusions Elevated levels of anxiety and emotional distress were found in those testing HPV+ compared with those testing HPV−. Future research should examine what strategies should be used to deliver test results and what additional information is provided, in order to alleviate anxiety among individuals testing HPV+. Anxiety and emotional distress are significantly greater in individuals who report testing human papillomavirus positive (HPV+) Knowledge of human papillomavirus (HPV) is high in individuals who report testing HPV+, but there are still some significant knowledge gaps Future research is needed to examine how individuals should best receive HPV test results, and what resources should be provided
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Affiliation(s)
| | - Kirsty F Bennett
- Department of Behavioural Science and Health Cancer Communication and Screening Group University College London London UK
| | - Kirsten J McCaffery
- School of Public Health The University of Sydney Faculty of Medicine and Health NSW2006 Australia
| | - Julia ML Brotherton
- VCS Population Health VCS Foundation Level 6, 176 Wellington Parade East Melbourne VIC3002 Australia
- Melbourne School of Population and Global Health University of Melbourne Victoria Australia
| | - Rachael H Dodd
- School of Public Health The University of Sydney Faculty of Medicine and Health NSW2006 Australia
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Nick N, Torabizadeh C, Ghahartars M, Janghorban R. Adaptation of patients diagnosed with human papillomavirus: a grounded theory study. Reprod Health 2021; 18:213. [PMID: 34702304 PMCID: PMC8547285 DOI: 10.1186/s12978-021-01264-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background Human papillomavirus is the most common cause of sexually transmitted diseases. Various studies report that positive human papillomavirus diagnosis results in psychosexual issues for the infected and reduces their quality of life. However, the adaptation of the infected has not been addressed yet. The present study aims to identify the process by which individuals infected with human papillomavirus adapt to their disease. Method This is a qualitative work of research with a grounded theory design. The setting of the study was the skin clinic of Shahid Faghihi Hospital in Shiraz. The participants consisted of 27 individuals: 18 patients, 3 doctors, 2 counselors, and 4 spouses of patients. The subjects were selected via purposeful and theoretical sampling method until data saturation was reached. Data were collected through face-to-face, in-depth, semi-structured interviews from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss’s method (2015) and MAXQDA 2018. Results The theory which emerged from the data was “trying to maintain resilience in the absence of psychological security.” Analysis of data showed the main concern of participants in adapting to their diagnosis with human papillomavirus was “life stress”. “Stigma and ignorance” was found to be a contextual condition and “paradox in support” was an intervening condition in the patients’ adaptation. The patients’ action/interaction responses to their main concern in the context in question were “emotional confrontation” and “maintaining resilience.” The outcome was “oscillation between tension and tranquility.” Conclusion The present study explains the process by which patients with human papillomavirus adapt to their condition. Identification of the concerns of patients with human papillomavirus and the factors which affect their adaptation can help healthcare policy-makers and providers develop effective support plans in order to increase patients’ quality of life. Early interventions, e.g. counseling care providers to modify their behaviors toward alleviating the psychosexual tension of the infected, can facilitate the adaptation of the infected and decrease the consequences of the infection for them. Graphical Abstract ![]()
Human papillomavirus (HPV) is the most common cause of sexually transmitted diseases. Almost all men and women get the infection at least once throughout their lives. The high-risk types of HPV account for about 5% of cancer cases globally. HPV can cause anogenital cancers and warts in both genders. In this grounded theory study, we conducted 27 in-depth interviews with Iranian patients, their spouses, and health care providers from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss’s method (2015) and MAXQDA 2018. The participants were concerned about tension in family relationships, being stigmatized, getting cancer, recurrence of warts, transferring their disease to others, and changes in the appearance of their genitalia. They stated that HPV is regarded as a shameful disease in society. Most of the participants said they had never heard anything about HPV. The patients’ action/interaction responses to their concerns were “emotional confrontation” and “maintaining resilience.” These strategies helped the patients recover some of their tranquility. However, some of patients’ concerns were persistent and kept them oscillating between tension and tranquility. An understanding of the patients’ perception of their disease is essential to development of effective educational interventions to change patients’ perspective on their situation and improve their recovery. Furthermore, because of the low level of public awareness about HPV and sexual health and the flow of misinformation to the infected, it is recommended that educational interventions focus on the patients’ concerns.
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Affiliation(s)
- Narjes Nick
- Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Ghahartars
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roksana Janghorban
- Department of Midwifery, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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