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

PLoS One. 2019 Dec 16;14(12):e0226261. doi: 10.1371/journal.pone.0226261. eCollection 2019.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Attitude to Health
  • Continuity of Patient Care / standards
  • Disease Progression
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Mass Screening / methods
  • Mass Screening / psychology
  • Medicalization*
  • Middle Aged
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / epidemiology
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / psychology
  • Patient Acceptance of Health Care* / psychology
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Perception*
  • Population Surveillance*
  • Practice Patterns, Physicians' / standards
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / psychology
  • Precancerous Conditions / therapy
  • Risk Factors
  • Risk Management / methods
  • Risk Management / standards
  • Social Behavior
  • Uterine Cervical Dysplasia* / diagnosis
  • Uterine Cervical Dysplasia* / epidemiology
  • Uterine Cervical Dysplasia* / psychology
  • Uterine Cervical Dysplasia* / therapy
  • Uterine Cervical Neoplasms* / diagnosis
  • Uterine Cervical Neoplasms* / epidemiology
  • Uterine Cervical Neoplasms* / psychology
  • Uterine Cervical Neoplasms* / therapy
  • Young Adult

Grants and funding

This work was supported by a grant from the Galician System of I + D + I [Xunta de Galicia, DOG Resolution No. 122, of 06/29/2016] and the INDITEX-UDC 2017 scholarship for an academic visit at the University of Toronto (CFV). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.