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Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: cross sectional questionnaire study

BMJ 2004; 328 doi: (Published 27 May 2004) Cite this as: BMJ 2004;328:1293
  1. Esther Maissi, researcher1,
  2. Theresa M Marteau, professor of health psychology (theresa.marteau{at},
  3. Matthew Hankins, research fellow1,
  4. Sue Moss, reader in cancer epidemiology2,
  5. Rosa Legood, researcher3,
  6. Alastair Gray, professor of health economics3
  1. 1Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London SE1 9RT
  2. 2Institute of Cancer Research, Cancer Screening Evaluation Unit, Sutton, Surrey SM2 5NG
  3. 3Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF
  1. Correspondence to: T M Marteau
  • Accepted 9 March 2004


Objective To describe the psychological impact on women of being tested for human papillomavirus (HPV) when smear test results are borderline or mildly dyskaryotic.

Design Cross sectional questionnaire study.

Setting Two centres participating in an English pilot study of HPV testing in women with borderline or mildly dyskaryotic smear test results.

Participants Women receiving borderline or mildly dyskaryotic smear test results tested for HPV and found to be HPV positive (n = 536) or HPV negative (n = 331); and women not tested for HPV with borderline or mildly dyskaryotic smear results (n = 143) or normal smear results (n = 366).

Main outcome measures State anxiety, distress, and concern about test result, assessed within four weeks of receipt of results.

Results Women with borderline or mildly dyskaryotic smear results who were HPV positive were more anxious, distressed, and concerned than the other three groups. Three variables independently predicted anxiety in HPV positive women: younger age (β = −0.11, P = 0.03), higher perceived risk of cervical cancer (β = 0.17, P < 0.001), and reporting that they did not understand the meaning of test results (β = 0.17, P = 0.001). Testing HPV negative was not reassuring: among women with abnormal smear test results, those who were HPV negative were no less anxious than those who were not tested for HPV.

Conclusions Informing women more effectively about the meaning of borderline or mildly dyskaryotic smear test results and HPV status, in particular about the absolute risks of cervical cancer and the prevalence of HPV infection, may avoid some anxiety for those who are HPV positive while achieving some reassurance for those who test HPV negative.


  • Contributors TMM, SM, and AG designed the study and together with RL designed the study questionnaire. EM collected and analysed the data. MH provided statistical advice and conducted some of the analyses. TMM and EM cowrote the first draft of the manuscript, which was read and commented on by the other four authors. TMM is guarantor

  • Funding Department of Health (Reference 1217215).

  • Competing interests None declared.

  • Ethical approval Southmead Local Research Ethics Committee (Reference No 076/01) and Northumberland and Tyne & Wear Health Authority Local Research Ethics Committee (Reference No 2001/247), which covered the laboratories that conducted the screening

  • Accepted 9 March 2004
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