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Published in: Archives of Gynecology and Obstetrics 3/2019

01-03-2019 | Human Papillomavirus | Gynecologic Oncology

The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case–control study

Authors: N. Rippinger, J. Heinzler, T. Bruckner, J. Brucker, C. Dinkic, J. Hoffmann, N. Dornhöfer, S. Seitz, J. Rom, C. Sohn, T. C. Schott, Sarah Schott

Published in: Archives of Gynecology and Obstetrics | Issue 3/2019

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Abstract

Purpose

Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women’s adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event.

Methods

Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1.

Results

132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 − 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1–S1/T2–S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study.

Conclusion

This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.
Literature
3.
go back to reference Marquardt KUB, Büttner HH, Barten M (2007) Zervixkarzinom trotz Früherkennungsprogramm—analyse von Teilnahmeraten und Tumorstadium. Frauenarzt 11/2007 Marquardt KUB, Büttner HH, Barten M (2007) Zervixkarzinom trotz Früherkennungsprogramm—analyse von Teilnahmeraten und Tumorstadium. Frauenarzt 11/2007
6.
go back to reference Chang AR (1990) Carcinoma in situ of the cervix and its malignant potential. A lesson from New Zealand. Cytopathology 1(6):321–328CrossRef Chang AR (1990) Carcinoma in situ of the cervix and its malignant potential. A lesson from New Zealand. Cytopathology 1(6):321–328CrossRef
7.
go back to reference Kinlen LJ, Spriggs AI (1978) Women with positive cervical smears but without surgical intervention. A follow-up study. Lancet (London, England) 2(8087):463–465CrossRef Kinlen LJ, Spriggs AI (1978) Women with positive cervical smears but without surgical intervention. A follow-up study. Lancet (London, England) 2(8087):463–465CrossRef
8.
go back to reference Ostor AG (1993) Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 12(2):186–192CrossRef Ostor AG (1993) Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 12(2):186–192CrossRef
9.
go back to reference Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IGWiG) (2011) Nutzenbewertung eines HPV-Tests im Primärsceening des Zervixkarzinoms (trans: (Auftraggeber) GB). Abschlussbericht S10-01, vol Version 1.0 Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IGWiG) (2011) Nutzenbewertung eines HPV-Tests im Primärsceening des Zervixkarzinoms (trans: (Auftraggeber) GB). Abschlussbericht S10-01, vol Version 1.0
10.
go back to reference Schiffman MH, Bauer HM, Hoover RN, Glass AG, Cadell DM, Rush BB, Scott DR, Sherman ME, Kurman RJ, Wacholder S et al (1993) Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia. J Natl Cancer Inst 85(12):958–964CrossRef Schiffman MH, Bauer HM, Hoover RN, Glass AG, Cadell DM, Rush BB, Scott DR, Sherman ME, Kurman RJ, Wacholder S et al (1993) Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia. J Natl Cancer Inst 85(12):958–964CrossRef
11.
go back to reference Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland Dripl. Kfm. H. Kerek Bodden, Dr. L. Altenhofen, Dr. G. Brenner (2008) Durchführung einer versichertenbezogenen Untersuchung zur Inanspruchnahme der Früherkennung auf Zervixkarzinom in den Jahren 2002, 2003 und 2004 auf der Basis von Abrechnungsdaten. http://www.ag-cpc.de/media/ZI-Abschlussbericht-080602.pdf. Accessed 1 May 2017 Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland Dripl. Kfm. H. Kerek Bodden, Dr. L. Altenhofen, Dr. G. Brenner (2008) Durchführung einer versichertenbezogenen Untersuchung zur Inanspruchnahme der Früherkennung auf Zervixkarzinom in den Jahren 2002, 2003 und 2004 auf der Basis von Abrechnungsdaten. http://​www.​ag-cpc.​de/​media/​ZI-Abschlussbericht​-080602.​pdf. Accessed 1 May 2017
12.
go back to reference Harlfinger W (2008) Prävention-das wichtigste Standbein der Frauenarztpraxis 2008 Heft Nr. Seite 9:772–778 Harlfinger W (2008) Prävention-das wichtigste Standbein der Frauenarztpraxis 2008 Heft Nr. Seite 9:772–778
15.
go back to reference Thangarajah F, Einzmann T, Bergauer F, Patzke J, Schmidt-Petruschkat S, Theune M, Engel K, Puppe J, Richters L, Mallmann P, Kirn V (2016) Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet 293(2):391–398. https://doi.org/10.1007/s00404-015-3821-z CrossRefPubMed Thangarajah F, Einzmann T, Bergauer F, Patzke J, Schmidt-Petruschkat S, Theune M, Engel K, Puppe J, Richters L, Mallmann P, Kirn V (2016) Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet 293(2):391–398. https://​doi.​org/​10.​1007/​s00404-015-3821-z CrossRefPubMed
17.
go back to reference IARC 2005 (2005) Cervix cancer screening. IARC handbooks of cancer prevention, vol 10, Chap 5: effectiveness of screening in populations IARC 2005 (2005) Cervix cancer screening. IARC handbooks of cancer prevention, vol 10, Chap 5: effectiveness of screening in populations
20.
go back to reference Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 282(18):1737–1744CrossRef Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 282(18):1737–1744CrossRef
24.
27.
go back to reference Vetter L, Keller M, Bruckner T, Golatta M, Eismann S, Evers C, Dikow N, Sohn C, Heil J, Schott S (2016) Adherence to the breast cancer surveillance program for women at risk for familial breast and ovarian cancer versus overscreening: a monocenter study in Germany. Breast Cancer Res Treat 156(2):289–299. https://doi.org/10.1007/s10549-016-3748-5 CrossRefPubMed Vetter L, Keller M, Bruckner T, Golatta M, Eismann S, Evers C, Dikow N, Sohn C, Heil J, Schott S (2016) Adherence to the breast cancer surveillance program for women at risk for familial breast and ovarian cancer versus overscreening: a monocenter study in Germany. Breast Cancer Res Treat 156(2):289–299. https://​doi.​org/​10.​1007/​s10549-016-3748-5 CrossRefPubMed
30.
go back to reference Flamant C, Gauthier E, Clavel-Chapelon F (2006) Determinants of non-compliance to recommendations on breast cancer screening among women participating in the French E3N cohort study. Eur J Cancer Prev 15(1):27–33CrossRef Flamant C, Gauthier E, Clavel-Chapelon F (2006) Determinants of non-compliance to recommendations on breast cancer screening among women participating in the French E3N cohort study. Eur J Cancer Prev 15(1):27–33CrossRef
37.
go back to reference Delere Y, Bohmer MM, Walter D, Wichmann O (2013) HPV vaccination coverage among women aged 18-20 years in Germany three years after recommendation of HPV vaccination for adolescent girls: results from a cross-sectional survey. Hum Vaccines Immunother 9(8):1706–1711. https://doi.org/10.4161/hv.24904 CrossRef Delere Y, Bohmer MM, Walter D, Wichmann O (2013) HPV vaccination coverage among women aged 18-20 years in Germany three years after recommendation of HPV vaccination for adolescent girls: results from a cross-sectional survey. Hum Vaccines Immunother 9(8):1706–1711. https://​doi.​org/​10.​4161/​hv.​24904 CrossRef
38.
go back to reference Sultana F, English DR, Simpson JA, Drennan KT, Mullins R, Brotherton JM, Wrede CD, Heley S, Saville M, Gertig DM (2016) Home-based HPV self-sampling improves participation by never-screened and under-screened women: results from a large randomized trial (iPap) in Australia. Int J Cancer 139(2):281–290. https://doi.org/10.1002/ijc.30031 CrossRefPubMed Sultana F, English DR, Simpson JA, Drennan KT, Mullins R, Brotherton JM, Wrede CD, Heley S, Saville M, Gertig DM (2016) Home-based HPV self-sampling improves participation by never-screened and under-screened women: results from a large randomized trial (iPap) in Australia. Int J Cancer 139(2):281–290. https://​doi.​org/​10.​1002/​ijc.​30031 CrossRefPubMed
39.
go back to reference Verdoodt F, Jentschke M, Hillemanns P, Racey CS, Snijders PJ, Arbyn M (2015) Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer (Oxford, England: 1990) 51(16):2375–2385. https://doi.org/10.1016/j.ejca.2015.07.006 CrossRef Verdoodt F, Jentschke M, Hillemanns P, Racey CS, Snijders PJ, Arbyn M (2015) Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer (Oxford, England: 1990) 51(16):2375–2385. https://​doi.​org/​10.​1016/​j.​ejca.​2015.​07.​006 CrossRef
40.
go back to reference Virtanen A, Nieminen P, Malila N, Luostarinen T, Anttila A (2013) Self-sampling and reminder letters increase participation in the Finnish cervical cancer screening programme. Duodecim; laaketieteellinen aikakauskirja 129(16):1709–1717PubMed Virtanen A, Nieminen P, Malila N, Luostarinen T, Anttila A (2013) Self-sampling and reminder letters increase participation in the Finnish cervical cancer screening programme. Duodecim; laaketieteellinen aikakauskirja 129(16):1709–1717PubMed
Metadata
Title
The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case–control study
Authors
N. Rippinger
J. Heinzler
T. Bruckner
J. Brucker
C. Dinkic
J. Hoffmann
N. Dornhöfer
S. Seitz
J. Rom
C. Sohn
T. C. Schott
Sarah Schott
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 3/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-5029-5

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