Archives of Gynecology and Obstetrics

, Volume 299, Issue 3, pp 847–855 | Cite as

The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case–control study

  • N. Rippinger
  • J. Heinzler
  • T. Bruckner
  • J. Brucker
  • C. Dinkic
  • J. Hoffmann
  • N. Dornhöfer
  • S. Seitz
  • J. Rom
  • C. Sohn
  • T. C. Schott
  • Sarah SchottEmail author
Gynecologic Oncology



Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women’s adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event.


Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1.


132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 − 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1–S1/T2–S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study.


This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.


Cervical dysplasia Conization Cancer prevention habits Adherence PHQ-D 



We gratefully acknowledge K. Weimer, MD for critical discussion, F. Cohrs, MD and L. Matthies, MD for their contribution in recruiting patients and K. Taylor for critical reading.

Author contributions

NR: manuscript writing/editing and data analysis. JH: data collection and management, data analysis, and manuscript editing. TB: data analysis and manuscript editing. JB: data collection. CD: data collection. JH: data collection. ND: data collection. SS: data collection. JR: manuscript editing. CS: manuscript editing. TCS: protocol/project development and manuscript editing. SS: protocol/project development, manuscript writing/editing, and project supervision.


This research was not funded by any grant or funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gynaecology and ObstetricsUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and Informatics (IMBI)University Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Gynaecology and ObstetricsLeipzig University HospitalLeipzigGermany
  4. 4.Department of Gynaecology and ObstetricsUniversity Medical Center RegensburgRegensburgGermany
  5. 5.Department of Orthodontics and Orofacial OrthopedicsUniversity Hospital TubingenTubingenGermany
  6. 6.German Cancer Consortium (DKTK)Heidelberg and German Cancer Research Centre (DKFZ)HeidelbergGermany

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