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Original research
Levels of anxiety and distress following receipt of positive screening tests in Australia’s HPV-based cervical screening programme: a cross-sectional survey
  1. Rachael Helen Dodd1,
  2. Olivia Mac1,
  3. Julia M L Brotherton2,3,
  4. Erin Cvejic1,
  5. Kirsten J McCaffery1
  1. 1 Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 VCS Population Health, Victorian Cytology Service, Carlton South, Victoria, Australia
  3. 3 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Rachael Helen Dodd, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; rachael.dodd{at}


Objective From December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme.

Methods Women in Australia aged 25–74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress.

Results 1004 women completed the online survey; 80.9% reported testing HPV negative (HPV−), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV−. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV−. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV−.

Conclusions Receipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.

  • cervical cytology
  • screening
  • HPV

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  • Handling editor Catherine H Mercer

  • Twitter @ErinCvejic

  • Correction notice The article has been corrected since it was published online first. The affiliation of Julia Brotherton has been updated.

  • Contributors RHD and KJM conceived, designed and developed the methods for the study. RHD coordinated the running of the study. RHD, OM and EC contributed to the analysis. RHD drafted the manuscript. JMLB contributed to the content and critical analysis. All authors contributed to the interpretation of the analysis and critically revised the manuscript.

  • Funding This work was supported by a NHMRC Program Grant (APP1113532).

  • Competing interests JMLB’s employer VCS Foundation has received donated human papillomavirus (HPV) tests kits and equipment for unrestricted research purposes from HPV test manufacturers including Roche, Cepheid, Seegene and Becton Dickinson.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by The University of Sydney Human Ethics Committee (2018/836).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.