What women want. Women's preferences for the management of low-grade abnormal cervical screening tests: a systematic review.

BACKGROUND

If human papillomavirus (HPV) testing will replace cytology in primary cervical screening, the frequency of low-grade abnormal screening tests will double. Several available alternatives for the follow-up of low-grade abnormal screening tests have similar outcomes. In this situation, women's preferences have been proposed as a guide for management decisions.

OBJECTIVES

To determine women's preferences for the follow-up of low-grade cervical screening abnormalities.

SEARCH STRATEGY

Using Medical Subject Headings (MeSH) terms, PubMed was searched for articles published up to December 2010. The reference lists of the retrieved studies were consulted.

SELECTION CRITERIA

Studies asking women to state a preference between active follow-up and observation for the management of low-grade abnormalities on screening cytology or HPV tests.

DATA COLLECTION AND ANALYSIS

Information on study design, participants and outcomes was retrieved using a prespecified form. Studies were sorted by design.

MAIN RESULTS

Thirteen studies were included in the review. In all five studies that surveyed women with abnormal tests before any management had started, two-thirds preferred active follow-up, predominantly as immediate colposcopy, to observation, predominantly as repeated Pap smears. In all but two studies testing other situations, women more often expressed a preference for active follow-up than for observation; however, women appeared to be somewhat more willing to accept observation if reassured of the low risk of cervical cancer.

CONCLUSIONS

Even for low-grade abnormal cervical tests, women tend to prefer active management strategies. It may be a challenge to meet their expectations of optimal follow-up when HPV testing is used in primary screening.