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HPV testing best option for women with abnormal smears

Research: Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: An open randomized trial

BMJ

For women with an abnormal smear test result, HPV testing is better for their psychosocial wellbeing compared with conventional repeat smear testing, finds new research published on bmj.com today.

HPV testing for women with borderline cervical abnormalities is available in the US and Europe and will soon be introduced into the cervical screening programme in England and Wales.

HPV testing has advantages but also potential downsides with respect to women's quality of life and psychosocial wellbeing, but these outcomes, and the option of offering women informed choice of management, have not been adequately assessed.

So researchers at the University of Sydney set out to assess which of three strategies for women with a borderline abnormal smear results in the best psychosocial outcomes over one year.

The study involved 314 women across Australia aged 16 to 70 years with a borderline smear who were randomised to one of three triage arms: HPV DNA testing, a repeat smear test at six months, or the patient's informed choice of either test supported by a decision aid.

Psychosocial outcomes were assessed at regular time points over 12 months. These included worry about cervical cancer, intrusive thoughts, and anxiety about the abnormal smear.

Demographic variables, such as age, education, employment, marital and relationship status, children and ethnicity were also measured.

After two weeks, some psychosocial outcomes were worse for women allocated to HPV testing compared with those in the smear testing group. However, over 12 months, distress about the abnormal smear was lowest in women allocated to HPV testing and highest in the repeat smear testing group.

Women in the HPV group and the informed choice group were more satisfied with their care than women allocated to repeat smear testing. However, the benefit of giving women an informed choice of either HPV testing or repeat smear testing supported by a decision aid is still uncertain, say the authors.

They conclude: Although the psychosocial effect was initially worse for women allocated to HPV triage, over the full year of follow-up this intervention was better for women's psychosocial health than repeat smear testing. These findings support the move towards HPV triage in the UK for women with borderline smear results.

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