***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE Referral for  colposcopy  because of abnormal Pap test results is likely to be distressing , but the extent and duration of these effects are unknown . We aim ed to fill this gap . METHODS We conducted a prospect i ve observational study at two departments of Obstetrics and Gynecology ( an academic and a non-academic setting ) . Women referred for colposcopy  completed question naires before colposcopy , and at 1 , 3 , and 6 months afterwards . A reference group of 706 screen participants , aged 29 - 60 years old , was included and completed question naires once . Main outcome measures were generic health-related quality of life ( HRQoL ) , assessed through the EQ-5D and the SF-12 physical and mental scores ( PCS-12 and MCS-12 ) ; anxiety as assessed by STAI-6 , and screen-specific anxiety as assessed by the psychological consequences question naire ( PCQ ) . RESULTS 154 women responded to the question naire , of whom 132 were included in the analyses . Histological results were CIN 1 in 17/115 women ( 15 % ) and CIN 2 + in 62 ( 54 % ) . In 36 women ( 31 % ) there was no histologically confirmed neoplasia . Before colposcopy physical HRQoL scores were similar or slightly better than in the reference group , while mental HRQoL ( MSC-12 ) and ( screen-specific ) anxiety were worse ( p<0.001 ) . Irrespective of CIN- grade s , anxiety washed out during follow-up ( p<0.001 ) , with changes being clinical ly relevant . CONCLUSIONS Referral for gynecological evaluation because of abnormal PAP-test results was distressing . Anxiety-- and not the physical burden of management -- seemed to be the most bothersome to women . For all CIN- grade s , distress disappeared over six months following colposcopy , suggesting a reassuring effect of gynecological management BACKGROUND Data on the impact of abnormal cervical smear results on health-related quality of life ( HrQoL ) are scarce . We aim ed to ( i ) prospect ively assess the HrQoL of women who were informed of an abnormal smear result ; ( ii ) identify predictors of greater negative psychosocial impact of an abnormal result ; and ( iii ) prospect ively estimate the quality -adjusted life-years ( QALYs ) lost following an abnormal result . METHODS Between 08/2006 and 08/2008 , 492 women with an abnormal result and 460 women with a normal result , frequency matched for age and clinic , were recruited across Canada .  HrQoL was measured at recruitment and 4 and 12 weeks later with the  EuroQol , Short Form-12 , short Spielberg State-Trait Anxiety Inventory ( STAI ) and HPV Impact Profile .  Three blocks of potential predictors of higher psychosocial impact were tested by hierarchical modeling : ( i ) socio-demographics ; ( ii ) sexual activity ; and ( iii ) smear result severity , communication , and underst and ing . RESULTS Receiving an abnormal result significantly increased anxiety ( STAI mean difference between both groups = 8.3 ) . Initial anxiety decreased over time for the majority of women . However , 35 % of women had clinical ly meaningful anxiety at 12 weeks ( i.e. STAI scores ≥0.5 st and ard deviation of the controls ) . These women reported a lower socio-economic level , did not completely underst and the information about their result and perceived themselves at higher risk of cancer . QALY lost following an abnormal result were between 0.007 and 0.009 . CONCLUSIONS Receiving an abnormal smear has a statistically significant and clinical ly meaningful negative impact on mental health . However , this negative impact subsides after 12 weeks for the majority of women State anxiety ( S-STAI-6 ) , distress ( GHQ-12 ) , concern and quality of life ( EuroQoL-EQ-5D ) 6 months after human papillomavirus ( HPV ) testing in women with borderline or mildly dyskaryotic smear test results were assessed based on a prospect i ve question naire study , with 6-month follow-up after the smear test result . Two centres participated in an English pilot study of HPV testing . Participants included two groups of women receiving abnormal smear test results : ( tested for HPV and found to be ( a ) HPV positive ( n=369 ) or ( b ) HPV negative ( n=252 ) ) and two groups not tested for HPV ( those receiving ( c ) abnormal smear test results ( n=102 ) or ( d ) normal smear test results ( n=288 ) ) . There were no differences in anxiety , distress or health-related quality of life between the four study groups at 6 months . Levels of concern about the smear test result remained elevated in all groups receiving an abnormal smear test result , and were highest in the group untested for HPV . Predictors of concern across all groups receiving an abnormal smear test were perceived risk of developing cancer , being HPV positive or untested for HPV , sexual health worries and the smear being a woman 's first smear test . The raised anxiety and distress observed in women immediately after being informed of an abnormal smear test result and that they are HPV positive was no longer evident at 6 months . Concern about the smear test result was however still raised in these women and those who tested negative for HPV , and particularly among those who did not undergo HPV testing CONTEXT Every year approximately 2 million US women are diagnosed as having a cervical cytological result of atypical squamous cells of undetermined significance ( ASC-US ) . OBJECTIVE To determine the most efficient and cost-effective management strategy for women in the United States diagnosed as having ASC-US . DESIGN AND SETTING Cost-effectiveness analysis of data from clinical trials , prospect i ve studies , and other published literature . A computer-based model was used to compare 4 management strategies for a cytological result of ASC-US : immediate colposcopy ; human papillomavirus ( HPV ) triage , which includes colposcopy if high-risk HPV types are detected ; repeat cytology , which includes follow-up cytology at 6 and 12 months and referral for colposcopy if a repeat abnormal result occurs ; and reclassifying ASC-US as normal in which a cytological result of ASC-US is ignored . Reflex HPV DNA testing uses either residual liquid-based cytological specimens or sample s co-collected at the time of the initial screening for conventional cytology . Another method , referred to as the 2-visit HPV DNA triage , requires a woman with an ASC-US result to return within 1 month to provide another speciman sample . MAIN OUTCOME MEASURES Years of life saved ( YLS ) , quality -adjusted life-years ( QALYs ) , and incremental cost-effectiveness ratios . RESULTS The least costly strategy for biennial screening was to reclassify ASC-US as normal , result ing in a reduction in total cancer incidence of 75 % for conventional cytology and 84 % for liquid-based cytology compared with no screening . The next least costly strategy was HPV DNA testing result ing in a reduction in total cancer incidence of 86 % for conventional cytology and 90 % for liquid-based cytology , followed by immediate colposcopy with a reduction of 87 % and 91 % , respectively . Compared with reflex HPV DNA testing , a strategy of repeat cervical cytology or delayed HPV testing costs more but is less effective . When all strategies were compared simultaneously , varying frequency and type of cytological test , biennial ( vs every 3 years ) liquid-based cytology with reflex HPV testing had a cost of $ 174 200 per YLS . In a similar comparison , liquid-based cytology with reflex HPV testing conducted every 3 years ( vs every 5 years ) had a cost of $ 59 600 per YLS and was more effective and less costly than a strategy of conventional cytology incorporating repeat cytology or immediate colposcopy conducted biennially . CONCLUSION Reflex HPV DNA testing provides the same or greater life expectancy benefits and is more cost-effective than other management strategies for women diagnosed as having ASC-US OBJECTIVE To evaluate health-related quality of Life ( HRQoL ) in patients with abnormal cervical cytology referred for colposcopy . STUDY DESIGN An observational study with prospect i ve and retrospective cohorts . In the prospect i ve arm 240 women referred for colposcopy filled in the 15D HRQoL and the State Anxiety Inventory ( STAI ) question naires and were followed up for 12 months . In the retrospective arm 208 patients who had been treated for cervical dysplasia eight years earlier filled in the 15D HRQoL question naire . Results were compared with the age- and sex-st and ardized general population . RESULTS In the prospect i ve part of the study , the mean 15D score of the patients did not differ from that of the general population . On the dimensions of sleeping , distress and sexual activity , however , the patients scored lower than the general population ( p<0.001 ) . Patients with higher levels of anxiety at baseline , according to the STAI question naire , had lower HRQoL during the whole 12-month observation period ( p<0.001 ) . The overall HRQoL score of the patients treated for cervical dysplasia eight years earlier did not differ from that of the general population . CONCLUSIONS Abnormal cytology and referral for colposcopy were associated with anxiety and slightly impaired psychosocial components of HRQoL but did not reduce the overall HRQoL. High anxiety levels at baseline were associated with impaired HRQoL. Previous treatment for cervical dysplasia was not associated with impaired overall Cervical screening reduces the risk of cervical cancer by detecting and treating cervical intraepithelial neoplasia ( CIN ) . The management of women with low- grade cervical abnormalities is controversial . Two management policies exist : repeat smears in primary care and colposcopy examination . It is not clear which of these is the more effective and efficient . There is also uncertainty as to the most effective and efficient management of women at colposcopy when an area of abnormality is seen on the cervix - immediate treatment or biopsy and selective recall for treatment if the biopsy result suggests this is necessary . The result of a human papillomavirus ( HPV ) test might assist in deciding the appropriate management of women with low- grade abnormalities . TOMBOLA , a pragmatic r and omised-controlled trial set within the cervical screening programmes in Scotl and and Engl and , addresses these three areas of uncertainty . Almost four and a half thous and women aged 20 - 59 with a low- grade cervical abnormality have been recruited and r and omised to either repeat smears or colposcopy examination . Women in the colposcopy arm of the trial are further r and omised to a policy of either immediate treatment or biopsy and selective recall for treatment if they have an abnormal transformation zone . Women are followed up to an exit examination at 3 years . HPV testing is undertaken at recruitment and at the exit examination . The primary endpoint is cumulative incidence of CIN2/3 . A range of other clinical , psychosocial and economic outcomes is being considered . This paper describes the design of the trial , and discusses the rationale underlying aspects of the design and the challenges faced in design ing and implementing the trial Abstract Objectives Genital human papillomavirus ( HPV ) infections and associated precancerous lesions adversely affect health-related quality of life ( HRQoL ) . HPV vaccines provide effective protection against these conditions . We therefore investigated the impact of HPV vaccination on HRQoL in young women five years after participation in a phase III HPV vaccination trial . Methods A total of 4808 originally 16- to 17-year-old Finnish girls had participated in the PATRICIA trial and received either bivalent HPV 16/18 vaccine or hepatitis A-virus ( HAV ) vaccine in 2004 to 2005 . Unvaccinated girls ( n = 9602 ) , from adjacent birth cohorts , had participated in the control cohort in 2005 . From 2009 to 2011 , at 22 to 23 years of age , all participants received a question naire consisting of two generic HRQoL instruments ( R AND 36 and EQ VAS ) and a disease-specific question naire ( CECA10 ) . Results We analysed responses of 1143 HPV 16/18-vaccinated , 980 HAV-vaccinated , and 3753 unvaccinated young women . The unadjusted mean outcome measures of the different HRQoL estimates were similar in the three different responder cohorts . Conclusions Five years after vaccination the health-related quality of life of HPV 16/ 18- vaccinated young women did not differ from those of HAV-vaccinated or unvaccinated controls representing the general population BACKGROUND Cervical intraepithelial neoplasia grade 2 or greater ( CIN2 + ) is the surrogate endpoint used in licensure trials of human papillomavirus ( HPV ) vaccines . Vaccine efficacy against CIN3 + , the immediate precursor to invasive cervical cancer , is more difficult to measure because of its lower incidence , but provides the most stringent evidence of potential cancer prevention . We report vaccine efficacy against CIN3 + and adenocarcinoma in situ ( AIS ) in the end-of- study analysis of PATRICIA ( PApilloma TRIal against Cancer In young Adults ) . METHODS Healthy women aged 1 
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Conclusions Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention and treatment .
The EQ-5D appears insufficiently sensitive for some health states .
A more general problem is the paucity of HRQoL estimates for many health states and their change over time