The double burden of HPV positivity in Chinese women with borderline abnormal cervical cytology

Abstract

Background: Reflex HPV testing for screening women with borderline cervical abnormalities is useful but may also compound the burden on those tested positive for HPV.

Objectives: To examine the psychosocial impact on women with concurrent abnormal cytology and positive HPV results.

Methods: Ethnic Chinese women who received reflex HPV testing following a borderline cytology result (ASCUS) were recruited from five community-based well women's clinics in Hong Kong. A group with normal cytology (HPV unknown) was included as control. The participants' psychological and psychosocial status was assessed with self-administered questionnaires immediately before and after smear result disclosure and by telephone interview 6 months afterwards. The adapted Breast Cancer Worry Scale and HPV Impact Profile (HIP) were used to measure cancer worry and HPV-related burden. We also asked women the chance that their smear results could be attributed to their sex partner. The findings of these outcomes measured immediately after results disclosure is presented.

Results: 685 women (aged 16 to 67 years) were recruited to form three groups of study subjects (ASCUS-HPV positive=275; ASCUS-HPV negative=212; control=198). In the HPV positive group, 32.8% felt quite/very worried about having cervical cancer in future (versus 13.9% and 3.6% in the HPV negative group and control group, respectively). In multivariate analysis, cytology-HPV status had significant overall effect on the outcomes (F=3.88, df=4, p=0.004). Controlling for the covariate age, pair wise comparisons showed that the HPV positive group had significantly higher cancer worry and HPV burden than the HPV negative group and control group. Among ASCUS women, 16.7% of HPV positive women versus 7.4% of HPV negative women believed there was a high/very high chance that their sex partner was responsible for their smear results.

Conclusions: HPV positivity intensified the psychological and psychosocial burden borne by women with a borderline cervical abnormality.