COVID-19 disruption to cervical cancer screening in England

Abstract

Introduction In England, routine invitations for cervical screening were reduced between April 2020 and June 2020 due to the COVID-19 pandemic. We quantify the impact of COVID-19 disruptions on attendance and excess diagnoses of cervical cancer (CC). Methods Using Public Health England CC screening data on laboratory samples received in 2018 as a baseline we quantify the reduction in screening attendances due to the COVID-19 pandemic between April 2020 and March 2021 for women aged 25–64. We model the impact on excess CC diagnoses assuming once invitations resume 87.5% of women attend within 12 months and 12.5% delay screening for 3 or 5 years (depending on age). Results The number of samples received at laboratories was 91% lower than expected during April, 85% during May and 43% during June 2020 compared to the same period in 2018. Although on average laboratories received 12.6% more samples between August 2020 and April 2021 than over the same months in 2018, by April 2021 there was a short fall of 200,949 samples (6.4% fewer than in 2018). An excess of 41 CC (4.0 per 100,000 women with a maximum screening delay of 12 months) are predicted to occur among the estimated 1,024,794 women attending this screening round with a delay. An excess of 60 CC (41.0 per 100,000 women) are predicted to occur among the estimated 146,391 women who do not attend this screening round. Conclusion Prompt restoration of cervical screening services limited the impact on excess CC diagnoses. However, in 2020 a 6.4% shortfall of screening samples was observed. Every effort should be made to reassure these women that services are open and safe to attend.

The impact of the Covid-19 pandemic on Italian population-based cancer screening activities and test coverage: results from national cross-sectional repeated surveys

“…For cervical cancer, it has been estimated that a delay of six months national screening program would lead to about 600 more cancers in England that would occur in the next screening round, in the absence of catch-up strategies. 7,41 We can expect a similar impact of screening disruption in Italy, where we observed a wide variability in the length of disruption, with a 6-month average delay in the invitations. 42…”

Cervical cancer screening improvements with self-sampling during the COVID-19 pandemic

“…In the US there was a 94% reduction of cervical cancer screenings during the initial phase of the pandemic compared to the same period the previous years, and although the screening has partially recovered since then, the cervical cancer screening rates are still 10% below prepandemic levels (18). Likewise, in England a 43-91% drop per month of received screening samples was observed during the period April to June 2020 and by April 2021 there was still 6,4% fewer samples than expected (19). Thus, although there was a prompt re-initiation of screening through re-opening of screening services and catch-up screening during the period following the initial phase of the pandemic, the impact of the disruption was significant.…”

“…As the cancellation of non-emergency healthcare also involved cancelling of follow-up and treatment of newly-detected screen-positive women, it has been speculated that a rise in cervical cancer would result (19, 21). We could, however, not see any such effect, probably because non-emergency healthcare was allowed again in June 2020 after a less than 3 months disruption.…”

“…The copyright holder for this preprint this version posted July 23, 2022. ; https://doi.org/10.1101/2022.07. 19.22277806 doi: medRxiv preprint debut who test HPV negative, the vaccine is equally effective as among subjects before sexual debut (16). By concomitant vaccination and HPV screening, HPV negative women will reap the full benefit of protection by vaccination and the HPV-positive women can be followed up as usual in the screening program (and are thus also protected against cervical cancer).…”

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

“…In other countries such as the United Kingdom (U.K.), 30% of survey respondents elicited Fall 2020 reported that they were less likely to attend cervical screening now than before the pandemic (10). Although the observed decrease in screening attendance ultimately was smaller than surveyed intentions to screen (11), the U.K. study also found that previous non-participation was the strongest predictor of low intentions for future postpandemic participation. Rebounds towards pre-pandemic attendance levels in aggregate-level metrics may suggest a successful recovery but could actually mask unexpected disparities in coverage.…”