How Has COVID-19 Impacted Cervical Cancer Screening?

The COVID-19 pandemic abruptly caused unexpected chaos all over the world. Healthcare was forced to quickly modify how patients were receiving care while at the same time attempting to manage the influx of sick patients, all with reduced staff. As a result, COVID-19 has impacted so many areas of medicine, including cervical cancer screening. The lessons learned thus far since the start of the COVID-19 pandemic can help implement changes that will improve cervical cancer screening. 

Non-Urgent Healthcare Visits and Elective Procedures Held

Limited healthcare staff and reduced supplies resulted in a temporary halt of elective visits. Stay-at-home orders and medical office closures prevented patients from attending annual health visits and the administration of scheduled vaccinations, such as the HPV vaccination.

In addition, secondary prevention of cervical cancer with pap testing was also on hold. A study found that in the USA, by March 2020, HPV vaccinations were reported to have dropped by greater than 70% when compared to prior years. The EPIC Health Research Network analyzed data from 60 healthcare organizations in 28 states. Data review found that cervical cancer screening dropped by 94% after the COVID-19 national emergency declaration [1].

Adjusting After The Start Of The Pandemic

Italy was one of the first countries heavily infected with COVID-19. Italian regions paused cervical screening programs in March 2020 for 4 months. The regional Healthcare Directorate sent out a survey to screening programs to determine how many tests were needed for the remaining 6 months when screening resumed in July. Multidisciplinary group meetings were held to address the delays in cervical cancer screening.

The decision was made to make scheduling changes moving forward that would accommodate screening an increased number of patients. These changes included having a fixed time interval for screening, allocating 15 minutes for each pap smear and 20 minutes for colposcopy. Prepandemic scheduling was more flexible without required appointment confirmations and no preassigned time slot. While these measures did prove useful, HPV self-sampling was considered for further process improvement [2].

Future Considerations

The COVID-19 pandemic is not over, and people are trying to adapt to a new normal. The increased adoption of telemedicine has shown significant benefits in reaching patients safely and extending care to a broader patient demographic. While pap smears cannot be performed via virtual visits, HPV-based screening with HPV self-sampling can.

Unlike cervical cytology, HPV testing can be performed in self-collected samples. Prior research has found that similar testing accuracy exists between clinician-collected samples and self-sampling. Visit scheduling priority can then be given to patients that are considered high-risk based on screening results.

Sources:

[1] Wentzensen, N., Clarke, M. A., & Perkins, R. B. (2021). Impact of COVID-19 on cervical cancer screening: challenges and opportunities to improving resilience and reduce disparities. Preventive Medicine, 151, 106596. https://doi.org/10.1016/j.ypmed.2021.106596

 

[2] Acuti Martellucci, C., Morettini, M., Flacco, M. E., Manzoli, L., Palmer, M., Giacomini, G., & Pasqualini, F. (2021). Delivering cervical cancer screening during the COVID-19 emergency. BMJ Sexual & Reproductive Health, 47(4), 296–299. https://doi.org/10.1136/bmjsrh-2021-201099