COVID-19 and cancer screening in Scotland: A national and coordinated approach to minimising harm

Abstract

Screening is an important component of cancer control internationally. In Scotland, the National Health Service Scotland provides screening programmes for cervical, bowel and breast cancers. The COVID-19 pandemic resulted in the suspension of these programmes in March 2020. We describe the integrated approach to managing the impact of the pandemic on cancer screening programmes in Scotland throughout 2020. We outline the policy context and decision-making process leading to suspension, and the criteria and framework informing the subsequent, staggered, restart in subsequent months. The decision to suspend screening services in order to protect screening invitees and staff, and manage NHS capacity, was made after review of numbers of screening participants likely to be affected, and the potential number of delayed cancer diagnoses. Restart principles and a detailed route map plan were developed for each programme, seeking to ensure broad consistency of approach across the programmes and nationally. Early data indicates bowel, breast and cervical screening participation has increased since restart. Primary care has had to adapt to new infection prevention control measures for delivery of cervical screening. Cancer charities provided cancer intelligence and policy briefs to national bodies and Scottish Government, as well as supporting the public, patients and screening invitees through information and awareness campaigns. Emerging from the pandemic, there is recognition of the need and the opportunity to transform and renew both cancer and screening services in Scotland, and in particular to address long-standing workforce capacity problems through innovation and investment, and to continue to prioritise addressing health inequalities.

Nimble Approach: fast, adapting, calculating and ethically mindful approach to managing colorectal cancer screening programmes during a pandemic

“…The findings align with published accounts of responses by individual breast, cervical, colorectal and lung cancer screening programmes 6 17 19 20 22 32–41. The literature ranged from reports from individual screening clinics or jurisdictions, to national cancer screening approaches.…”

The impact of COVID-19 on oncology professionals—one year on: lessons learned from the ESMO Resilience Task Force survey series

“… 3 , 4 , 5 Additional temporising measures such as suspension of ‘non-essential’ palliative chemotherapy, cancer screening services, and favouring of less intensive treatment regimens have also impacted the nature of our work with potential for longer-term consequences. 6 , 7 , 8 , 9 …”

Health impacts of COVID-19 disruptions to primary cervical screening by time since last screen: A model-based analysis for current and future disruptions

“…Although our analysis was contextualized to the U.S., our results may still be generalizable to other countries where cervical screening was disrupted such as the U.K., Ireland, New Zealand, and the Netherlands where cervical screening was paused for 2-4 months (23)(24)(25)(26). We considered combinations of screening modality and screening frequency, some of which will be more applicable to some countries than others.…”