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When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance


Autoři: Carla Freijomil-Vázquez aff001;  Denise Gastaldo aff003;  Carmen Coronado aff001;  María-Jesús Movilla-Fernández aff001
Působiště autorů: Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain aff001;  Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain aff002;  Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada aff003;  Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226261

Souhrn

Background

After the early detection of cervical intraepithelial neoplasia (CIN), medical surveillance of the precancerous lesions is carried out to control risk factors to avoid the development of cervical cancer.

Objective

To explore the effects of medical surveillance on the personal and social lives of women undergoing CIN follow-up and treatment.

Methodology

A generic qualitative study using a poststructuralist perspective of risk management was carried out in a gynecology clinic in a public hospital of the Galician Health Care System (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed, and a thematic analysis was carried out, including researcher triangulation to verify the results of the analysis.

Findings

Two main themes emerged from the participants’ experiences: CIN medical surveillance encounters and risk management strategies are shaped by the biomedical discourse, and the effects of “risk treatment” for patients include (a) profound changes expected of patients, (b) increased patient risk management, and (c) resistance to risk management. While doctors’ surveillance aimed to prevent the development of cervical cancer, women felt they were sick because they had to follow strict recommendations over an unspecified period of time and live with the possibility of a life-threatening disease. Clinical risk management resulted in the medicalization of women’s personal and social lives and produced great uncertainty.

Conclusions

This study is the first to conceptualize CIN medical surveillance as an illness experience for patients. It also problematizes the effects of preventative practices in women’s lives. Patients deal with great uncertainty, as CIN medical surveillance performed by gynecologists simultaneously trivializes the changes expected of patients and underestimates the effects of medical recommendations on patients’ personal wellbeing and social relations.

Klíčová slova:

Cancer prevention – Cervical cancer – Human papillomavirus infection – Lesions – Medical doctors – Oncology – Risk management – Women's health


Zdroje

1. World Health Organization [Internet]. Human papillomavirus (HPV) and cervical cancer, Geneva: World Health Organization; 2019, [cited 2019 Jul 28]. Human papillomavirus (HPV) and cervical cancer; [about 10 screens]. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

2. De Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017 Aug 15;141(4):664–670. doi: 10.1002/ijc.30716 28369882

3. Information Centre on HPV and Cancer. Human papillomavirus and related cancers, fact sheet 2018 [Internet]. Spain: Information Centre on HPV and Cancer; 2018 [cited 2019 Feb 13]. Available from: http://www.hpvcentre.net/statistics/reports/ESP_FS.pdf

4. Ministerio de Sanidad, Consumo y Bienestar Social. Calendario común de vacunación a lo largo de toda la vida [Internet]. Spain: Ministerio de Sanidad, Consumo y Bienestar Social; 2019 [cited 2019 Aug 1]. Available from: https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/CalendarioVacunacion_Todalavida.pdf

5. Asociación Española de Patología Cervical y Colposcopia. Guía de cribado del cáncer de cuello de útero en España [Internet]. Spain: Asociación Española de Patología Cervical y Colposcopia; 2014 [cited 2019 Feb 10]. Available from: http://www.aepcc.org/wp-content/uploads/2015/05/AEPCC_revista01.pdf

6. Royal Decree-Law No 1030/2006, which establishes the portfolio of common services of the Spanish National Health System and the procedure for its updating. Official State Gazette, No 222 (September 16, 2006)

7. Asociación Española de Patología Cervical y Colposcopia. Prevención del cáncer de cuello de útero [Internet]. Spain: Asociación Española de Patología Cervical y Colposcopia; 2014 [cited 2019 Mar 23]. Available from: http://www.aepcc.org/wp-content/uploads/2016/01/AEPCC_revista02.pdf

8. Falls RK. Spontaneous resolution rate of grade 1 cervical intraepithelial neoplasia in a private practice population. Am J Obstet Gynecol. 1999 Aug;181(2):278–82. doi: 10.1016/s0002-9378(99)70548-x 10454669

9. World Health Organization. WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ [Internet]. Geneva: World Health Organization; 2014 [cited 2019 Mar 23]. Available from: https://apps.who.int/iris/bitstream/handle/10665/104174/9789241506779_eng.pdf;jsessionid=49A8CAA731D89C0AE513BB0D24AE0FD4?sequence=1

10. Roura E, Castellsagué X, Pawlita M, Travier N, Waterboer T, Margall N et al. Smoking as a major risk factor for cervical cancer and pre‐cancer: Results from the EPIC cohort. Int J Cancer. 2014 Jul 15;135(2):453–66. doi: 10.1002/ijc.28666 24338632

11. Asociación Española de Patología Cervical y Colposcopia. Métodos anticonceptivos, infección VPH, y lesiones premalignas de cuello uterino [Internet]. Spain: Asociación Española de Patología Cervical y Colposcopia; 2018 [cited 2018 Mar 22]. Available from: http://www.aepcc.org/wp-content/uploads/2019/01/AEPCC_revista09-Anticonceptivos-web.pdf

12. Asociación Española de Patología Cervical y Colposcopia. Vacunación selectiva frente al Virus del Papiloma Humano en poblaciones de riesgo elevado [Internet]. Spain: Asociación Española de Patología Cervical y Colposcopia; 2016 [cited 2019 Mar 22]. Available from: http://www.aepcc.org/wp-content/uploads/2016/12/AEPCC_revista07_VACUNACION-SELECTIVA.pdf

13. McRae J, Martin C, O’Leary J, Sharp L. “If you can’t treat HPV, why test for it?” Women’s attitudes to the changing face of cervical cancer prevention: a focus group study. BMC Women’s Health. 2014 May 6;14:64. doi: 10.1186/1472-6874-14-64 24885650

14. Markovic-Denic L, Djuric O, Maksimovic N, Popovac S, Kesic V. Effects of Human Papillomavirus Awareness and Knowledge on Psychological State of Women Referred to Cervical Cancer Screening. J Low Genit Tract Di. 2018 Jul;22(3):178–183. doi: 10.1097/LGT.0000000000000397 29672447

15. O’Connor M, Costello L, Murphy J, Prendiville W, Martin CM, O’Leary J et al. Influences on human papillomavirus (HPV)-related information needs among women having HPV tests for follow-up of abnormal cervical cytology. J Fam Plann Reprod Health Care. 2015 Apr;41(2):134–41. doi: 10.1136/jfprhc-2013-100750 25248873

16. Mortensen LG, Adeler AL. Qualitative study of women’s anxiety and information needs after a diagnosis of cervical dysplasia. Z Gesundh Wiss. 2010 Oct;18(5):473–482. doi: 10.1007/s10389-010-0330-1 21151479

17. Castro-Vásquez MC, Arellano-Gálvez MC. [Access to information by women with HPV, cervical dysplasia and cancer in situ]. Salud Publica Mex. 2010 May-Jun;52(3):207–12. doi: 10.1590/s0036-36342010000300004 20485883

18. Fish LJ, Moorman P, Wordlaw-Stintson L, Vidal A, Smith JS, Hoyo C. Factors Associated With Adherence to Follow-up Colposcopy. Am J Health Educ. 2013;44:293–8. doi: 10.1080/19325037.2013.838881 24991653

19. Thangarajah F, Einzmann T, Bergauer F, Patzke J, Schmidt-Petruschkat S, Theune M et al. Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet. 2016 Feb;293(2):391–8. doi: 10.1007/s00404-015-3821-z 26202136

20. Arellano-Gálvez MC, Castro-Vásquez MC. [The stigma in women diagnosed with HPV, dysplasia and cervical cancer in Hermosillo, Sonora] Estud Soc. 2013;21(42):259–278.

21. Cook C. The sexual health consultation as a moral occasion. Nurs Inq. 2014 Mar;21(1):11–9. doi: 10.1111/nin.12018 23336250

22. Oliveira de Melo R, Rocha-Moreira RC, Mendonça-Lopes RL. [Cervical cancer precursor lesions: significance for women in a referral center in Brazil] Revista de Pesquisa: Cuidado é fundamental online. 2015; 7(4): 3327–3338.

23. De Melo Pessanha-Carvalho MC, Azevedo-Queiroz AB, Vasconcelos-Moura MA. Social images among women with precursory lesions of cervical cancer: study of social representations. Rev enferm UERJ [Internet]. 2014 [cited 2019 May 1]; 22(3): [about 10 p.]. Available from: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/13729/10503

24. Foucault M. The birth of the clinic. London: Routledge; 2003 [1963].

25. Foucault M. The History of Sexuality. Volume 1: An Introduction. London: Penguin Books; 1990 [1976].

26. Gastaldo D. Is health education good for you? Re-thinking health education through the concept of bio-power. In: Petersen A, Bunton R, editors. Foucault, Health and Medicine. London: Routledge; 1997, p. 113–133.

27. Lupton D. Medicine as Culture: illness, disease and the body. 3rd ed. SAGE; 2012.

28. Rose N. The Politics of Life Itself. Princeton: Princeton University Press; 2007.

29. Lupton D. Risk. 2nd ed. New York: Routledge; 2013.

30. Bover AB, Gastaldo D. [The centrality of the family as a resource for homecare: gender and generational perspectives]. Rev Bras Enferm. 2005;58:9–16. doi: 10.1590/s0034-71672005000100002 16268276

31. Nack A. From the patient's point of view: Practitioner interaction styles in the treatment of women with chronic STD. In: Kronenfeld JJ, editor. Care for Major Health Problems and Population Health Concerns: Impacts on Patients, Providers and Policy. USA: Emerald Group Publishing Limited; 2008, p. 95–122.

32. Connell E, Hunt A. The HPV vaccination campaign: A project of moral regulation in an era of biopolitics. Can J Sociol. 2010;35:63. doi: 10.29173/cjs6689

33. Polzer J, Mancuso FV, Rudman DL. Risk, responsibility, resistance: Young women’s negotiations of identity and healthy citizenship in human papillomavirus (HPV) vaccination narratives. Narrat Inq. 2014;24:281–308. doi: 10.1075/ni.24.2.06pol

34. Rail G, Molino L, Fusco C, Norman ME, Petherick L, Polzer J et al. HPV vaccination discourses and the construction of “at-risk” girls. Can J Public Health. 2018;109:622–632. doi: 10.17269/s41997-018-0108-8 30076535

35. Mishra A, Graham JE. Risk, choice and the ‘girl vaccine’: Unpacking human papillomavirus (HPV) immunisation. Health Risk Soc. 2012;14:57–69. doi: 10.1080/13698575.2011.641524

36. Engels KS. Biopower, normalization, and HPV: A Foucauldian analysis of the HPV vaccine controversy. J Med Humanit. 2016 Sep;37(3):299–312. doi: 10.1007/s10912-015-9361-5 26438668

37. Burns K, Davies C. Constructions of young women’s health and wellbeing in neoliberal times: a case study of the HPV Vaccination Program in Australia. In: Wright K, McLeod J, editors. Rethinking Youth Wellbeing. Springer, Singapore; 2015: p. 71–89

38. Armstrong N. Resistance through risk: Women and cervical cancer screening. Health Risk Soc. 2005;7:161–176. doi: 10.1080/13698570500108644

39. Stagg-Taylor J. Australian pap smear registers and the creation of gendered identities. Griffith Law Review. 2013;22:504–531. doi: 10.1080/10383441.2013.10854785

40. Wyndham-West M, Durand N, Santoro A. Betwixt and Between Well and Sick in Cervical Precancer: Canadian Women’s Experiences of Recurring HPV Infections and HPV Vaccination. Can J Nurs Res. 2018 Sep;50(3):120–132. doi: 10.1177/0844562118763496 29759001

41. Caelli K., Ray L, Mill J. “Clear as mud”: Toward greater clarity in generic qualitative research. International Journal of Qualitative Methods. 2003;2(2):1–24. doi: 10.1177/160940690300200201

42. Ritchie J, Lewis J. Designing and selecting samples. In: Ritchie J, Lewis J, editors. Qualitative Research Practice; A Guide for Social Science Students and Researchers. Sage, Los Angeles; 2003: p.77–104

43. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016 Nov;26(13):1753–1760. doi: 10.1177/1049732315617444 26613970

44. Thorne S. Interpretive description: Qualitative research for applied practice. 2nd ed. New York: Routledge; 2016.

45. Meyer S, Ward P. ‘How to’ use social theory within and throughout qualitative research in healthcare contexts. Sociology Compass. 2014 May;8(5):525–539. doi: 10.1111/soc4.12155

46. Guba E, Lincoln Y. Fourth Generation Evaluation. Newbury Park: Sage; 1989

47. Authors (published article)

48. Gifford SM. The meaning of lumps: a case study of the ambiguities of risk. In: Janes CR, Stall R, Gifford SM, editors. Anthropology and epidemiology. Dordrecht: Springer; 1986, p. 213–246.

49. Pessanha-Carvalho MC, Azevedo-Queiroz AB, Ferreira MDA. The social representations of women of reproductive age on cervical cancer precursor lesions. Texto & Contexto-Enfermagem. 2013;22:943–951. doi: 10.1590/S0104-07072013000400010

50. Hernández-Corrochano E. La maternidad después de…: Estudio etnográfico de la maternidad primípara tardía en España. Revista de Antropología Iberoamericana. 2016;11(1):79–103. doi: 10.11156/aibr.110105

51. Wang A, Cui G, Jin C, Wang Y, Tian X. Multicenter research on tumor and pregnancy outcomes in patients with early-stage cervical cancer after fertility-sparing surgery. J Int Med Res. 2019 Jul;47(7):2881–2889. doi: 10.1177/0300060519845974 31115262

52. Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS. The importance of fertility preservation counseling in patients with gynecologic cancer. J Reprod Infertil. 2017 Apr-Jun;18(2):261–263 28868252

53. Valenti G, Vitale SG, Tropea A, Biondi A, Laganà AS. Tumor markers of uterine cervical cancer: a new scenario to guide surgical practice? Updates Surg. 2017 Dec;69(4):441–449. doi: 10.1007/s13304-017-0491-3 28918603

54. Nicol AF, de Andrade CV, Brusadelli MG, Lodin HM, Wells SI et al. The distribution of novel biomarkers in carcinoma-in-situ, microinvasive, and squamous cell carcinoma of the uterine cervix. Ann Diagn Pathol. 2019 Feb;38:115–122. doi: 10.1016/j.anndiagpath.2018.12.001 30579259

55. Lupton D. Perspectives on power, communication and the medical encounter: implications for nursing theory and practice. Nurs Inq. 1995 Sep;2(3):157–63. doi: 10.1111/j.1440-1800.1995.tb00166.x 7664160

56. Polzer J. Caring for the Self, Caring for Others: The Politics and Ethics of Generic Risk for Breast Cancer. Canadian woman studies, 2010;28(2):71–76

57. Jiménez-Ruiz I, Moya-Nicolás M. [The family caregiver: the naturalized sense of obligation in women to be caregivers]. Enferm Glob. 2018;17(49):420–447. doi: 10.6018/eglobal.17.1.292331

58. Farrington EM, Bell DC, DiBacco AE. Reasons People Give for Using (or Not Using) Condoms. AIDS Behav. 2016 Dec;20(12):2850–2862. doi: 10.1007/s10461-016-1352-7 26969001

59. Bjekić M, Sipetić-Grujičić S, Vlajinac H, Nikolić A. Reasons for not using condoms among heterosexual men in Belgrade, Serbia. Acta Dermatovenerol Croat. 2018 Apr;26(1):58–60 29782302

60. Cioe PA, Gordon RE, Guthrie KM, Freiberg MS, Kahler CW. Perceived barriers to smoking cessation and perceptions of electronic cigarettes among persons living with HIV. AIDS Care. 2018 Nov;30(11):1469–1475. doi: 10.1080/09540121.2018.1489103 29927614

61. Rzeszutek M. Health-related quality of life and coping strategies among people living with HIV: the moderating role of gender. Arch Womens Ment Health. 2018 Jun;21(3):247–257. doi: 10.1007/s00737-017-0801-2 29256068


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