Psychosocial Issues in Cervical Cancer Screening

Dear Colleagues,

Worldwide, cervical cancer is the 4th most common cancer among women. It is a leading cause of cancer-related death in women in Eastern, Western, Middle, and Southern Africa. A combination of vaccination against human papillomavirus (HPV) types which cause cervical cancer and screening has the potential to eradicate this deadly disease. Although well-organised screening programmes are effective in reducing cervical cancer incidence and mortality rates in the population, these achievements are accompanied by substantial costs to the women involved. These include economic costs associated with attending for smears and follow-up investigations, physical costs of complications such as bleeding and pain, and psychosocial costs. The psychosocial impact of cervical cancer screening is an important and often overlooked harm. Studies have shown that women can suffer from anxiety, worry or distress at various points in their screening journey—worry about attending for their first smear test, anxiety around waiting for test results, or uncertainty around the meaning of their test results. Women who have had a negative smear test experience may have concerns about attending their next screening test. Physical pain and discomfort during these tests and follow-up exams (e.g., colposcopy) can be associated with psychological distress. Women can also experience psychological and physical after-effects (e.g., bleeding) of follow-up investigations for abnormal cervical cells or treatment to remove abnormal cervical cells. The scientific evidence on cervical screening has evolved and screening is changing as a result. Persistent infections with certain types of human papillomavirus (HPV) infection are causal agents for development of cervical precancer (CIN) and cancer. HPV testing is now being used instead of (primary HPV testing), or in conjunction to traditional smear tests in some countries. Among women who do not attend for screening tests, HPV self-sampling is being considered as an alternative. Testing positive for HPV infection and undergoing HPV testing itself may bring additional psychosocial costs for women, mainly as HPV is mostly transmitted through sexual contact. Understanding why some women have negative screening experiences and identifying which women are at greatest risk of suffering adverse psychological outcomes can help to develop initiatives/interventions to protect against these potential harms and minimise distress for women. This Special Issue will focus on research undertaken around the psychosocial impact of cervical screening. Cervical cancer screening and the psychosocial burden differ between countries and populations of women—studies undertaken in low, and middle-income countries are encouraged, as well as studies conducted in high-income countries. Qualitative papers which report on original research conducted among women, health professionals involved in cervical screening (at any point in the screening journey), and other key stakeholders are particularly welcome. Quantitative papers, papers on interventions to ameliorate psychological burden, and systematic reviews are also very welcome. The keywords listed below are not intended as an exhaustive list.

Dr. Mairead O'Connor
Guest Editor

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• cervical cancer screening
• abnormal smear test result
• CIN
• HPV infection
• colposcopy
• worry
• anxiety
• psychological
• psychosocial issues