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Prev Med ; 151: 106623, 2021 10.
Article in English | MEDLINE | ID: covidwho-1240652


COVID-19 has disrupted cervical screening in several countries, due to a range of policy-, health-service and participant-related factors. Using three well-established models of cervical cancer natural history adapted to simulate screening across four countries, we compared the impact of a range of standardised screening disruption scenarios in four countries that vary in their cervical cancer prevention programs. All scenarios assumed a 6- or 12-month disruption followed by a rapid catch-up of missed screens. Cervical screening disruptions could increase cervical cancer cases by up to 5-6%. In all settings, more than 60% of the excess cancer burden due to disruptions are likely to have occurred in women aged less than 50 years in 2020, including settings where women in their 30s have previously been offered HPV vaccination. Approximately 15-30% of cancers predicted to result from disruptions could be prevented by maintaining colposcopy and precancer treatment services during any disruption period. Disruptions to primary screening had greater adverse effects in situations where women due to attend for screening in 2020 had cytology (vs. HPV) as their previous primary test. Rapid catch-up would dramatically increase demand for HPV tests in 2021, which it may not be feasible to meet because of competing demands on the testing machines and reagents due to COVID tests. These findings can inform future prioritisation strategies for catch-up that balance potential constraints on resourcing with clinical need.

COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Mass Screening , Papillomavirus Infections/diagnosis , Papillomavirus Infections/prevention & control , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
Lancet Public Health ; 6(7): e522-e527, 2021 07.
Article in English | MEDLINE | ID: covidwho-1211226


Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.

COVID-19 , Early Detection of Cancer , Mass Screening , Pandemics , Uterine Cervical Neoplasms/diagnosis , Female , Health Services Accessibility , Healthcare Disparities , Humans , SARS-CoV-2
Br J Cancer ; 124(8): 1361-1365, 2021 04.
Article in English | MEDLINE | ID: covidwho-1072147


BACKGROUND: The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened. METHODS: Using routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25-49 and 5 years at ages 50-64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay. RESULTS: Both scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities-they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000). CONCLUSION: To ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.

COVID-19/diagnosis , Early Detection of Cancer , Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , Adult , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Colposcopy/methods , England/epidemiology , Female , Humans , Middle Aged , Pandemics , Papillomaviridae/pathogenicity , Papillomavirus Infections/complications , Papillomavirus Infections/epidemiology , Papillomavirus Infections/virology , Pregnancy , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , Uterine Cervical Neoplasms/complications , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/virology , Vaginal Smears/methods