https://orcid.org/0000-0003-2099-253X
Abstract
Background
The incidence of cervical cancer peaks around the age of 75 years, and elderly patients are more frequently diagnosed with advanced-stage cervical cancer than younger patients. There is considerable practice variation regarding follow-up of elderly patients with abnormal cervical test results at risk of cervical cancer, both nationally and internationally, due to uncertainty about risks and benefits for this particular patient group. The treatment preferences of these patients are, however, poorly described in the current literature. The aim of this study was to explore elderly patients’ experiences with abnormal cervical test results and preferences for follow-up.
Materials and Methods
We performed focus group interviews with seventeen Danish patients aged 60–79 years who had undergone biopsy and colposcopy in gynaecological outpatient clinics or at private gynaecologists due to a positive human papillomavirus (HPV) test result and/or abnormal cytology. A focus group interview guide was designed to cover experiences with abnormal cervical test results, including realistic risk and benefit scenarios related to underdiagnosis and overtreatment. Data were analysed thematically using a phenomenological approach.
Results
The patients were surprised that elderly could also have an HPV infection. Most preferred treatment and follow-up at the gynaecologist over continuous control visits at the general practitioner. In case of persistent HPV infection and cervical intraepithelial neoplasia, a quick solution including cone biopsy was preferred even if it carried a risk of overtreatment. The patients wanted clear recommendations and demonstrated considerable intolerance towards healthcare professionals’ clinical uncertainty regarding optimum follow-up.
Conclusion
Most elderly patients wanted closure involving cone biopsy, and they expressed tolerance towards overtreatment to reduce their risk of cervical cancer. Thus, clinicians should present known risks and benefits to elderly patients facing risk of overtreatment after abnormal cervical test results.
Acknowledgments
The authors wish to thank the healthcare professionals who recruited the study participants and the patients who participated in the focus groups. We confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the accounts.
Author Contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Disclosure
LWG received speaker’s fee from Astra Zeneca and CINtec PLUS kits from Roche Diagnostic for a clinical study (NCT04298957), outside of the submitted work. BA received HPV test kits for other studies from Roche and self-sampling kits for other studies from Axlab. BA is also the head of Department of Public Health Programmes being responsible for cervical cancer screening in Central Denmark Region. The authors report no other conflicts of interest in this work.