Women fear that the trust between couples in long term relationships and marriage could be undermined if tests for a sexually transmitted virus were to form part of the screening process for cervical cancer – according to a new report1.
The study, by Cancer Research UK scientists, has found that lack of information and understanding about Human Papillomavirus (HPV)2, the main cause of cervical cancer, could lead to huge emotional distress for women.
Researchers used focus groups to consult women from different ethnic backgrounds about their reactions to testing for HPV – a common sexually transmitted infection some strains of which can put people at higher risk of developing cervical cancer.
Women from white British, African Caribbean, Indian and Pakistani communities were consulted using focus groups. Results showed that while some women welcomed the new test as a possible improvement to cervical screening, many women were more concerned with the relationship difficulties that could follow a positive test result.
Professor Jane Wardle, head of Cancer Research UK’s Health Behaviour Unit at University College, London, says: “This study shows that while HPV testing is welcomed by some as a means of improving cervical screening, there are potential psychological and social costs which must be considered very carefully.
“Although the scientific community has long known of the link between cervical cancer and sexual activity, the debate over HPV testing makes it explicit for the first time, and this is shocking to many women.”
Jo Waller, a health psychologist and joint author of the study, says: “Steps must be taken to ensure public education about HPV is provided to both women and their partners so that this new information about the cause of cervical cancer does not deter women from attending screening and lead to unnecessary social and psychological harm”.
Researchers found that the test could raise questions about sexual partners in terms of trust, fidelity and promiscuity and lead to questions about how the infection had been contracted and when. This was a particular concern for married women and those in long term relationships.
Some women, particularly married women from the Indian and Pakistani groups, also believed that the simple act of attending screening could send messages of distrust to their partner or lead to questions about their own fidelity: “He will accuse me of sleeping with someone else” was one reaction. Some women also viewed the test as a chance “to know if our husbands are being faithful or not.”
Importantly, the study found that many women were unaware that HPV was the main cause of cervical cancer and women expressed shock, surprise and even fear that cervical cancer was linked to a sexually transmitted virus. There was confusion between high risk types of HPV and other low risk types of HPV such as genital warts, which are not associated with an increased cancer risk.
Researchers found that more information about HPV was needed, in terms of its transmission: how it is spread, its ability to lie ‘silent’ for many years and how to prevent infection. They reported that women wanted this information made available to their husbands and partners. Researchers concluded that this information would be critical to manage any potential harmful impact of HPV testing.
Sir Paul Nurse, Chief Executive of Cancer Research UK, said: “It is always important to take into account any psychological disadvantages when assessing practical ways of improving detection for disease. Studies like this one are particularly valuable in looking at the responses of a varied ethnic group.”
- British Journal of Cancer
- There are many different types of Human Papilloma Virus or HPV. It is sometimes called the wart virus as some types of HPV cause genital and other kinds of warts. The types of this virus that cause genital warts are not the same types that cause cervical cancer. Certain types of HPV are considered ‘high risk’ for cancer of the cervix.
People infected with any of these ‘high risk’ types are more at risk of developing pre-cancerous cells or cervical cancer. Most women who get cervical cancer have had an infection with a high risk strain of HPV. High risk types of HPV can cause changes in the cells covering the cervix that make them more likely to become cancerous in time. But the vast majority of women infected with these viruses do not develop cervical cancer indicating there are other factors at work.
HPV is an extremely common sexually transmitted infection. It is estimated that up to 80% of women who are sexually active will be infected with the virus at some point in their life-time. In the vast majority of women, HPV infection is cleared by the immune system and has no long-term effect.
However, in a small proportion of women HPV infection is not cleared and may lead to abnormal cell changes that put women at a higher risk of developing cervical cancer. Signs of HPV infection can appear within about three months but HPV can also lie dormant or ‘silent’ for up to 20 years in some women and cause no symptoms. This means it may be very difficult for any woman to know when she became infected.
HPV testing offers the opportunity to test for the presence of HPV in women. UK trials are currently underway to determine whether the addition of HPV testing to conventional cytology will improve cervical screening.