The impact of the COVID‐19 pandemic on the Ontario Cervical Screening Program, colposcopy and treatment services in Ontario, Canada: a population‐based study

Abstract

Objective: To describe the immediate impact of the COVID-19 pandemic on cervical screening, colposcopy and treatment volumes in Ontario, Canada. Design: Population-based retrospective observational study Setting: Ontario, Canada Population: People with a cervix age 21 to 69 years who completed at least one cervical screening cytology test, colposcopy or treatment procedure for cervical dysplasia between January 2019 and August 2020. Methods: Administrative databases were used to compare cervical screening cytology, colposcopy and treatment procedure volumes before (historical comparator) and during the first six months of the COVID-19 pandemic (March to August 2020). Main Outcome Measures: Changes in cervical screening cytology, colposcopy, and treatment volumes; individuals with high-grade cytology awaiting colposcopy. Results: During the first six months of the COVID-19 pandemic, the monthly average number of cervical screening cytology tests, colposcopies and treatments decreased by 63.8% (range: -92.3% --41.0%), 39.7% (range: -75.1% --14.3%) and 31.1% (range: -43.5% --23.6%), respectively, when compared to the corresponding months in 2019. Between March and August 2020, on average 292 (-51.0%) fewer high-grade cytological abnormalities were detected through screening each month. As of August 2020, 1,159 (29.2%) individuals with high-grade screening cytology were awaiting follow-up colposcopy.Conclusions: The COVID-19 pandemic has had a substantial impact on key cervical screening and follow-up services in Ontario. As the pandemic continues, ongoing monitoring of service utilization to inform system response and recovery is required. Future efforts to understand the impact of COVID-19-related disruptions on cervical cancer outcomes will be needed.Funding: This study was conducted with the support of Ontario Health (Cancer Care Ontario) through in-kind contributions.

Mitigating COVID-19’s impact on missed and delayed cancer diagnoses

“…2 Some backlogs persisted, with 33% of Ontarians with high-grade screening cervical cytology results before the start of the pandemic still awaiting colposcopy as of August 2020. 6 Patients living in neighbourhoods in the lowest income quintile were more likely to have diagnostic delays following an abnormal breast, colorectal, or cervical screening result than were those in higher-income neighbourhoods. 2 Patient hesitancy to be seen in person, coupled with the rise of virtual care and decreased health care resources for diagnosis, including biopsy and imaging, reduced the number of symptomatic cancers diagnosed.…”

Early Welsh cervical screening programme learning as a consequence of the coronavirus pandemic

“…A 94% drop in cervical screening was reported in May 2020 in the US with a catch-up programme seen as a priority. 11 A 63.8% decrease of cervical cytology screening tests was reported in Ontario 12 and an 82% drop was reported in the gynaecological cytology workload in the Asia-Pacific region. 13 The authors stressed the importance of effective laboratory biosafety protocols which may have an impact on the capacity for testing.…”

“…A 94% drop in cervical screening was reported in May 2020 in the US with a catch‐up programme seen as a priority 11 . A 63.8% decrease of cervical cytology screening tests was reported in Ontario 12 and an 82% drop was reported in the gynaecological cytology workload in the Asia‐Pacific region 13 …”

Effect of the COVID‐19 pandemic on oncology screenings: it is time to change course

“…Although cancer treatment has been guaranteed during the COVID‐19 pandemic, screenings have been suspended and/or severely reduced worldwide during the first and second waves due to the reprioritisation of health services, 1 as was clearly highlighted by Meggetto et al. 2 In a report about a cervical screening programme in Ontario, recent data on the effect of screening discontinuation during the first wave demonstrated increased delays in cancer diagnosis and treatment. Notably, population‐based studies reported a 30% reduction in primary care consultations and a 12–15% reduction in the number of referrals for both colorectal and breast cancer, with a significant increase in more advanced stages of disease compared with the same period in 2019.…”

“…Notably, population‐based studies reported a 30% reduction in primary care consultations and a 12–15% reduction in the number of referrals for both colorectal and breast cancer, with a significant increase in more advanced stages of disease compared with the same period in 2019. 2 , 3 …”