[COVID-19 and breast cancer screening in Brazil: a comparative analysis of the pre-pandemic and pandemic periods]. / COVID-19 e rastreamento do câncer de mama no Brasil: uma análise comparativa dos períodos pré-pandêmico e pandêmico.

The scope of this study was to evaluate the impacts of COVID-19 on breast cancer screening in Brazil. Data were collected from the Ambulatory Information System relating to "bilateral screening mammography" from January/2015 to December/2021. Analyses were performed by region and for Brazil. The average of exams in each month of the year was calculated based on 2015-2019 data, which was compared, monthly, with the number of exams in 2020 and 2021, obtaining the gross and percentage difference between these values. The same analysis was performed for the total number of exams in 2020 and 2021, individually, and for the two years combined. In 2020 there were reductions in the number of exams, which ranged from 25% (North) to 48% (Northeast), resulting in 1.749 million fewer exams than expected in the country (a drop of 44%). In 2021, the Midwest region presented a number of exams 11% higher than expected, while the other regions presented drops between 17% (North) and 27% (Southeast/South), resulting in 927 thousand exams fewer than expected in Brazil (reduction of 23%). In the joint analysis (2020/2021), reductions varied by region from 11% (Midwest) to 35% (Southeast/South), culminating in 2.676 million exams fewer than expected in Brazil (reduction of 33%).

Objetivou-se avaliar os impactos da COVID-19 no rastreamento do câncer de mama no Brasil. Coletaram-se dados do Sistema de Informações Ambulatoriais referentes a "mamografia bilateral para rastreamento" de janeiro/2015 a dezembro/2021. As análises foram feitas por região e para o Brasil. Calculou-se a média de exames em cada mês do ano com base nos dados de 2015 a 2019, a qual foi comparada, mensalmente, com o quantitativo de exames em 2020 e 2021, obtendo-se a diferença bruta e percentual entre esses valores. A mesma análise foi realizada para o número total de exames em 2020 e 2021, individualmente, e para os dois anos em conjunto. Em 2020 houve quedas no número de exames que variaram de 25% (Norte) a 48% (Nordeste), culminando em 1,749 milhão de exames a menos no país (queda de 44%). Em 2021, a região Centro-Oeste apresentou quantitativo de exames 11% superior ao esperado, enquanto as demais regiões apresentaram quedas entre 17% (Norte) e 27% (Sudeste/Sul), culminando em negativo de 927 mil exames no país (redução de 23%). Na análise conjunta (2020/2021), encontraram-se reduções que variaram de 11% (Centro-Oeste) a 35% (Sudeste/Sul), culminando em negativo de 2,676 milhões de procedimentos no Brasil (queda de 33%).

No woman left behind: achieving cervical cancer elimination among women living with HIV.

Cervical cancer is the fourth most common malignancy in women of reproductive age globally. The burden of this disease is highest in low-income and middle-income countries, especially among women living with HIV. In 2018, WHO launched a global strategy to accelerate cervical cancer elimination through rapid scale-up of prophylactic vaccination, cervical screening, and treatment of precancers and cancers. This initiative was key in raising a call for action to address the stark global disparities in cervical cancer burden. However, achieving elimination of cervical cancer among women with HIV requires consideration of biological and social issues affecting this population. This Position Paper shows specific challenges and uncertainties on the way to cervical cancer elimination for women living with HIV and highlights the scarcity of evidence for the effect of interventions in this population. We argue that reaching equity of outcomes for women with HIV will require substantial advances in approaches to HPV vaccination and improved understanding of the long-term effectiveness of HPV vaccines in settings with high HIV burden cervical cancer, just as HIV, is affected by social and structural factors such as poverty, stigma, and gender discrimination, that place the elimination strategy at risk. Global efforts must, therefore, be galvanised to ensure women living with HIV have optimised interventions, given their substantial risk of this preventable malignancy.

Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey.

Background: Home-based self-sampling for human papillomavirus (HPV) testing may be an alternative for women not attending clinic-based cervical cancer screening. Methods: We assessed barriers to care and motivators to use at-home HPV self-sampling kits during the COVID-19 pandemic as part of a randomized controlled trial evaluating kit effectiveness. Participants were women aged 30-65 and under-screened for cervical cancer in a safety-net healthcare system. We conducted telephone surveys in English/Spanish among a subgroup of trial participants, assessed differences between groups, and determined statistical significance at p<0.05. Results: Over half of 233 survey participants reported that clinic-based screening (Pap) is uncomfortable (67.8%), embarrassing (52.4%), and discomfort seeing male providers (63.1%). The last two factors were significantly more prevalent among Spanish vs English speakers (66.4% vs 30% (p=0.000) and 69.9 vs 52.2% (p=0.006), respectively). Most women who completed the kit found Pap more embarrassing (69.3%), stressful (55.6%), and less convenient (55.6%) than the kit. The first factor was more prevalent among Spanish vs English speakers (79.6% vs 53.38%, p=0.001) and among patients with elementary education or below. Conclusions: The COVID-19 pandemic influenced most (59.5%) to participate in the trial due to fear of COVID, difficulty making appointments, and ease of using kits. HPV self-sampling kits may reduce barriers among under-screened women in a safety-net system. Funding: This study is supported by a grant from the National Institute for Minority Health and Health Disparitie s (NIMHD, R01MD013715, PI: JR Montealegre). Clinical trial number: NCT03898167.

HPV prevalence and genotype distribution among women in eastern China during the Covid-19 pandemic.

Since March 2020, the pandemic caused by SARS-CoV-2 has affected nearly all aspects of daily life. In this study, we investigated the age-stratified prevalence and genotype distribution of human papillomavirus (HPV) among females in Shandong province (eastern China) and aimed to provide guidance on HPV-based cervical cancer screening and vaccination. The distribution of HPV genotypes was analyzed using PCR-Reverse Dot Hybridization. The overall infection rate of HPV was 16.4%, which was dominated by high-risk genotypes. The most prevalent genotype was HPV16 (2.9%), followed by HPV52 (2.3%), HPV53 (1.8%), HPV58 (1.5%), and HPV51 (1.3%). Among the positive cases with HPV infection, single-genotype infection was significantly higher than that of multi-genotype infection. In subgroup analyses by age (≤25, 26-35, 36-45, 46-55, >55), HPV16, 52, and 53 were consistently the three most common hrHPV genotypes in all age groups. The infection rate of multi-genotypes in the ≤25 and >55 age groups was significantly higher than that in other age groups. A bimodal distribution of HPV infection rate was observed in different age groups. Among lrHPV genotypes, HPV6, HPV11, and HPV81 were the three most common types in the ≤25 age group, while in other age groups, HPV81, HPV42, and HPV43 are the three most common lrHPV genotypes. This study provides basic information on the distribution and genotypes of HPV in the female population in eastern China, which could improve the application of HPV diagnostic probes and vaccines.

Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers: Practice Changes and Recovery Strategies.

BACKGROUND: The coronavirus disease 2019 pandemic led to clinical practice changes, which affected cancer preventive care delivery. OBJECTIVES: To investigate the impact of the coronavirus disease 2019 pandemic on the delivery of colorectal cancer (CRC) and cervical cancer (CVC) screenings. RESEARCH DESIGN: Parallel mixed methods design using electronic health record data (extracted between January 2019 and July 2021). Study results focused on 3 pandemic-related periods: March-May 2020, June-October 2020, and November 2020-September 2021. SUBJECTS: Two hundred seventeen community health centers located in 13 states and 29 semistructured interviews from 13 community health centers. MEASURES: Monthly up-to-date CRC and CVC screening rates and monthly rates of completed colonoscopies, fecal immunochemical test (FIT)/fecal occult blood test (FOBT) procedures, Papanicolaou tests among age and sex-eligible patients. Analysis used generalized estimating equations Poisson modeling. Qualitative analysts developed case summaries and created a cross-case data display for comparison. RESULTS: The results showed a reduction of 75% for colonoscopy [rate ratio (RR) = 0.250, 95% CI: 0.224-0.279], 78% for FIT/FOBT (RR = 0.218, 95% CI: 0.208-0.230), and 87% for Papanicolaou (RR = 0.130, 95% CI: 0.125-0.136) rates after the start of the pandemic. During this early pandemic period, CRC screening was impacted by hospitals halting services. Clinic staff moved toward FIT/FOBT screenings. CVC screening was impacted by guidelines encouraging pausing CVC screening, patient reluctance, and concerns about exposure. During the recovery period, leadership-driven preventive care prioritization and quality improvement capacity influenced CRC and CVC screening maintenance and recovery. CONCLUSIONS: Efforts supporting quality improvement capacity could be key actionable elements for these health centers to endure major disruptions to their care delivery system and to drive rapid recovery.

Interventions to increase cervical screening uptake among immigrant women: A systematic review and meta-analysis.

Numerous intervention studies have attempted to increase cervical screening uptake among immigrant women, nonetheless their screening participation remains low. This systematic review and meta-analysis aimed to summarise the evidence on interventions to improve cervical screening among immigrant women globally and identify their effectiveness. Databases PubMed, EMBASE, Scopus, PsycINFO, ERIC, CINAHL and CENTRAL were systematically searched from inception to October 12, 2021, for intervention studies, including randomised and clinical controlled trials (RCT, CCT) and one and two group pre-post studies. Peer-reviewed studies involving immigrant and refugee women, in community and clinical settings, were eligible. Comparator interventions were usual or minimal care or attention control. Data extraction, quality appraisal and risk of bias were assessed by two authors independently using COVIDENCE software. Narrative synthesis of findings was carried out, with the main outcome measure defined as the cervical screening uptake rate difference pre- and post-intervention followed by random effects meta-analysis of trials and two group pre-post studies, using Comprehensive Meta-Analysis software, to calculate pooled rate ratios and adjustment for publication bias, where found. The protocol followed PRISMA guidelines and was registered prospectively with PROSPERO (CRD42020192341). 1,900 studies were identified, of which 42 (21 RCTS, 4 CCTs, and 16 pre-post studies) with 44,224 participants, were included in the systematic review, and 28 with 35,495 participants in the meta-analysis. Overall, the uptake difference rate for interventions ranged from -6.7 to 96%. Meta-analysis demonstrated a pooled rate ratio of 1.15 (95% CI 1.03-1.29), with high heterogeneity. Culturally sensitive, multicomponent interventions, using different modes of information delivery and self-sampling modality were most promising. Interventions led to at least 15% increase in cervical screening participation among immigrant women. Interventions designed to overcome logistical barriers and use multiple channels to communicate culturally appropriate health promotion messages are most effective at achieving cervical screening uptake among immigrant women.

The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic.

The unprecedented onset of the COVID-19 crisis poses a significant challenge to all fields of medicine, including dermatology. Since the start of the coronavirus outbreak, a stark decline in new skin cancer diagnoses has been reported by countries worldwide. One of the greatest challenges during the pandemic has been the reduced access to face-to-face dermatologic evaluation and non-urgent procedures, such as biopsies or surgical excisions. Teledermatology is a well-integrated alternative when face-to-face dermatological assistance is not available. Teledermoscopy, an extension of teledermatology, comprises consulting dermoscopic images to improve the remote assessment of pigmented and non-pigmented lesions when direct visualisation of lesions is difficult. One of teledermoscopy's greatest strengths may be its utility as a triage and monitoring tool, which is critical in the early detection of skin cancer, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. Mobile teledermoscopy may act as a communication tool between medical practitioners and patients. By using their smartphone (mobile phone) patients can monitor a suspicious skin lesion identified by their medical practitioner, or alternatively self-detect concerning lesions and forward valuable dermoscopic images for remote medical evaluation. Several mobile applications that allow users to photograph suspicious lesions with their smartphones and have them evaluated using artificial intelligence technology have recently emerged. With the growing popularity of mobile apps and consumer-involved healthcare, this will likely be a key component of skin cancer screening in the years to come. However, most of these applications apply artificial intelligence technology to assess clinical images rather than dermoscopic images, which may lead to lower diagnostic accuracy. Incorporating the direct-to-consumer mobile dermoscopy model in combination with mole-scanning artificial intelligence as a mobile app may be the future of skin cancer detection.

Comparison of two frailty screening tools in older patients with colorectal cancer.

INTRODUCTION: Geriatric assessment (GA) is widely used to detect vulnerability in older patients. As this process is time-consuming, prescreening tools have been developed to identify patients at risk for frailty. We aimed to assess whether the Geriatric 8 (G8) or the Korean Cancer Study Group Geriatric Score (KG-7) shows better performance in identifying patients who are in need of full GA. MATERIALS AND METHODS: A consecutive series of patients aged ≥ 60 years with colorectal cancer were included. The sensitivity, specificity, predictive value, and 95% confidence intervals (95% CI) were calculated for the G8 and the KG-7 using the results of GA as the reference standard. ROC(Receiver Operating Characteristic) was used to evaluate the accuracy of the G8 and the KG-7. RESULTS: One hundred four patients were enrolled. A total of 40.4% of patients were frail according to GA, and 42.3% and 50.0% of patients were frail based on the G8 and the KG-7, respectively. The sensitivity and specificity of the G8 were 90.5% (95% CI: 77.4-97.3%) and 90.3% (95% CI: 80.1-96.4%), respectively. For the KG-7, the sensitivity and specificity were 83.3% (95% CI: 68.6-93.0%) and 72.6% (95% CI: 59.8-83.1%), respectively. Compared to the KG-7, the G8 had a higher predictive accuracy (AUC: (95% CI): 0.90 (0.83-0.95) vs. 0.78 (0.69-0.85); p < 0.01). By applying the G8 and the KG-7, 60 and 52 patients would not need a GA assessment, respectively. CONCLUSION: Both the G8 and the KG-7 showed a great ability to detect frailty in older patients with colorectal cancer. In this population, compared to the KG-7, the G8 had a better performance in identifying those in need of a full Geriatric Assessment.

Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening.

Importance: Breast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal. Objective: To provide race and ethnicity-adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality. Design, Setting, and Participants: This nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to 2020. Exposures: Proxy-reported race and ethnicity information was used. The risk-adapted starting age of BC screening by race and ethnicity was measured based on 10-year cumulative risk of BC-specific death. Age-specific 10-year cumulative risk was calculated based on age group-specific mortality data without modeling or adjustment. Main Outcomes and Measures: Disease-specific mortality due to invasive BC in female patients. Results: There were BC-specific deaths among 415 277 female patients (1880 American Indian or Alaska Native [0.5%], 12 086 Asian or Pacific Islander [2.9%], 62 695 Black [15.1%], 28 747 Hispanic [6.9%], and 309 869 White [74.6%]; 115 214 patients died before age 60 years [27.7%]) of any age in the US in 2011 to 2020. BC mortality per 100 000 person-years for ages 40 to 49 years was 27 deaths in Black females, 15 deaths in White females, and 11 deaths in American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander females. When BC screening was recommended to start at age 50 years for all females with a 10-year cumulative risk of BC death of 0.329%, Black females reached this risk threshold level 8 years earlier, at age 42 years, whereas White females reached it at age 51 years, American Indian or Alaska Native and Hispanic females at age 57 years, and Asian or Pacific Islander females 11 years later, at age 61 years. Race and ethnicity-adapted starting ages for Black females were 6 years earlier for mass screening at age 40 years and 7 years earlier for mass screening at age 45 years. Conclusions and Relevance: This study provides evidence-based race-adapted starting ages for BC screening. These findings suggest that health policy makers may consider a risk-adapted approach to BC screening in which individuals who are at high risk are screened earlier to address mortality due to early-onset BC before the recommended age of mass screening.

Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review.

BACKGROUND AND OBJECTIVES: Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care. METHODS: We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies. RESULTS: After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal ( n  = 10), breast ( n  = 4), cervical ( n  = 2), and prostate ( n  = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous. CONCLUSION: Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.

Projected long-term effects of colorectal cancer screening disruptions following the COVID-19 pandemic.

The aftermath of the initial phase of the COVID-19 pandemic may contribute to the widening of disparities in colorectal cancer (CRC) outcomes due to differential disruptions to CRC screening. This comparative microsimulation analysis uses two CISNET CRC models to simulate the impact of ongoing screening disruptions induced by the COVID-19 pandemic on long-term CRC outcomes. We evaluate three channels through which screening was disrupted: delays in screening, regimen switching, and screening discontinuation. The impact of these disruptions on long-term CRC outcomes was measured by the number of life-years lost due to CRC screening disruptions compared to a scenario without any disruptions. While short-term delays in screening of 3-18 months are predicted to result in minor life-years loss, discontinuing screening could result in much more significant reductions in the expected benefits of screening. These results demonstrate that unequal recovery of screening following the pandemic can widen disparities in CRC outcomes and emphasize the importance of ensuring equitable recovery to screening following the pandemic.

COVID-19 as a catalyst for reimagining cervical cancer prevention.

Cervical cancer has killed millions of women over the past decade. In 2019 the World Health Organization launched the Cervical Cancer Elimination Strategy, which included ambitious targets for vaccination, screening, and treatment. The COVID-19 pandemic disrupted progress on the strategy, but lessons learned during the pandemic - especially in vaccination, self-administered testing, and coordinated mobilization on a global scale - may help with efforts to achieve its targets. However, we must also learn from the failure of the COVID-19 response to include adequate representation of global voices. Efforts to eliminate cervical cancer will only succeed if those countries most affected are involved from the very start of planning. In this article we summarize innovations and highlight missed opportunities in the COVID response, and make recommendations to leverage the COVID experience to accelerate the elimination of cervical cancer globally.

Quantification of impact of COVID-19 pandemic on cancer screening programmes - a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand.

It is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income countries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) categories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the backlogs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.

Breast Cancer Champions: a peer-to-peer education and mobile mammography program improving breast cancer screening rates for women of African heritage.

INTRODUCTION: Nationally, women of African heritage die at higher rates from breast cancer than women of other races or ethnicities. We developed Breast Cancer Champions (BCC) a peer-to-peer education program, which recruited 12 women and deployed them into the community in August 2020 during the height of the COVID pandemic. BCC aims to improve breast cancer screening rates for women of African heritage through peer-to-peer education, which has proven successful for addressing cancer-related health disparities. METHODS: BCC community experts, or "Champions," are peer-to-peer educators that conduct awareness and screening events in their communities. Champion's education activities were tracked by bi-weekly check-in calls, which recorded the activity type, location, and the number of participants for each event. We used spatial and statistical analyses to determine the efficacy of the program at increasing screening rates for women within the area of Champion activity versus women outside of their activity area. RESULTS: Over 15 months, Champions conducted 245 in-person or online events to engage women in their community for screening. More women of African heritage were screened in areas Champions were active during the intervention compared to historical data comparing areas outside of the Champion activity in the prior 15 months (X 2 = 3.0845, p = 0.079). CONCLUSION: BCC successes could be attributed to pivoting to online community building when in-person events were restricted and enabling Champions to design and conduct their own events, which increased outreach possibilities. We demonstrate improved screening outcomes associated with an updated peer-to-peer education program.

Updated Review of Major Cancer Risk Factors and Screening Test use in the United States, with a Focus on Changes During the COVID-19 Pandemic.

We present national and state representative prevalence estimates of modifiable cancer risk factors, preventive behaviors and services, and screening, with a focus on changes during the COVID-19 pandemic. Between 2019 and 2021, current smoking, physical inactivity, and heavy alcohol consumption declined, and human papillomavirus vaccination and stool testing for colorectal cancer screening uptake increased. In contrast, obesity prevalence increased, while fruit consumption and cervical cancer screening declined during the same timeframe. Favorable and unfavorable trends were evident during the second year of the COVID-19 pandemic that must be monitored as more years of consistent data are collected. Yet disparities by racial/ethnic and socioeconomic status persisted, highlighting the continued need for interventions to address suboptimal levels among these population subgroups.

Coverage of cervical cancer screening in Uruguay, 2018 / Cobertura de tamizaje de cáncer de cuello de útero en Uruguay, 2018 / Cobertura do rastreamento do câncer do colo do útero no Uruguai, 2018

Introducción: el cáncer de cuello uterino (CCU) causa una significativa pérdida de años por discapacidad y muerte prematura en el mundo. Se relaciona fuertemente, por su etiología, a las inequidades socioeconómicas. Alcanzar una cobertura del 80% del tamizaje poblacional a través de la colpocitología oncológica constituye una de las principales estrategias para disminuir la morbimortalidad por este cáncer. Objetivos: describir la cobertura de tamizaje en CCU de las mujeres de 21 a 64 años, usuarias del Sistema Nacional Integrado de Salud (SNIS) de Uruguay en el año 2018 y explorar su comportamiento según edad, lugar de residencia, características socioeconómicas y culturales del territorio. Métodos: estudio descriptivo, en base a fuentes de datos secundarios, con una muestra que alcanzó el 95% del universo. La técnica de tamizaje considerada fue la colpocitología oncológica de (PAP) con vigencia de hasta 3 años al 30/9/2018. Resultados: la cobertura de tamizaje en CCU en 2018 fue del 57%, siendo menor en las primeras y últimas edades consideradas, variando por zona geográfica, encontrándose menor porcentaje de PAP vigente en las mujeres residentes en departamentos con menores índices de desarrollo humano y con mayor porcentaje de hogares por debajo de la línea de pobreza. Conclusiones: la cobertura de tamizaje en CCU en Uruguay debe aumentar para disminuir la morbimortalidad por este cáncer. Se requiere implementar acciones para reducir la heterogeneidad entre edades y departamentos de residencia. Esta estimación constituye una línea de base que permite comparar la situación país pospandemia COVID-19 replicando la misma metodología.

Summary: Introduction: cervical cancer causes a significant loss of years due to disabilities and early deaths around the world. Due to its etiology, it is closely linked to socio- economic inequalities. Cervical cancer screening coverage of 80 % of the population through and pap smear constitutes one of the main strategies to reduce morbimortality of this kind of cancer. Objectives: to describe cervical cancer screening coverage in women between 21 and 64 years old, users of the National Integrated Health System (SNIS) in Uruguay in 2018 and explore their behavior according to age, place of residence, socio-economic and territorial cultural characteristics. Method: descriptive study, based on secondary data sources of a sample representing 95% of the universe. The screening technique considered in the study was a pap smear, valid for up to three years on September 30, 2019. Results: cervical cancer screening coverage in 2018 was 57%, lower in the first and last ages considered and it varied depending on the geographical area. A lower percentage of valid smear tests was found in women who were residents of provinces with lower human development index and a higher percentage of homes below the poverty line. Conclusions: cervical cancer screening coverage in Uruugay needs to increase in order to reduce morbimortality. The implementation of actions aimed at reducing differences between ages and places of residence is required. This estimation may be taken as a baseline that allows for a comparison with the post-COVID 19 pandemic situation, by replicating the same method.

Introdução: o câncer do colo do útero (CCU), causa uma perda significativa de anos por incapacidade e morte prematura no mundo estando fortemente relacionada, por sua etiologia, às iniquidades socioeconômicas. Uma das principais estratégias para reduzir a morbimortalidade por esse câncer é alcançar 80% de cobertura de rastreamento populacional por meio da colpocitologia oncológica. Objetivos: descrever a cobertura do rastreamento do CCU em mulheres de 21 a 64 anos, usuárias do Sistema Nacional Integrado de Saúde (SNIS) do Uruguai em 2018 e analisar seu comportamento de acordo com idade, local de residência, características socioeconômicas e culturais do território. Métodos: estudo descritivo, baseado em fontes de dados secundárias de uma amostra que atingiu 95% do universo. A técnica de rastreamento considerada foi a colpocitologia oncológica (PAP) válida por até 3 anos a partir de 30/09/2018. Resultados: a cobertura de rastreamento no CCU em 2018 foi de 57%, sendo menor nas primeiras e últimas idades consideradas, variando por área geográfica, encontrando menor percentual de PAP atual em mulheres residentes em departamentos com menores índices de desenvolvimento humano e com maior percentual de famílias abaixo da linha de pobreza. Conclusões: deve-se aumentar a cobertura de rastreamento no CCU no Uruguai para reduzir a morbimortalidade por esse câncer. É necessário implementar ações para reduzir a heterogeneidade entre idades e departamentos de residência. Essa estimativa constitui uma linha de base que permite comparar a situação do país pós-pandemia por COVID-19, replicando a mesma metodologia.

The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening. METHODS: Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals. RESULTS: The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer). CONCLUSIONS: After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.

Impact of delayed screening invitations on screen-detected and interval cancers in the Dutch colorectal cancer screening programme: individual-level data analysis.

OBJECTIVE: To assess the impact of delayed invitation on screen-detected and interval colorectal cancers (CRC) within a faecal immunochemical testing (FIT)-based CRC screening programme. DESIGN: All individuals that participated in 2017 and 2018 with a negative FIT and were eligible for CRC screening in 2019 and 2020 were included using individual-level data. Multivariable logistic regression analyses were used to assess the association between either the different time periods (ie, 'before', 'during' and 'after' the first COVID-19 wave) or the invitation interval on screen-detected and interval CRCs. RESULTS: Positive predictive value for advanced neoplasia (AN) was slightly lower during (OR=0.91) and after (OR=0.95) the first COVID-19 wave, but no significant difference was observed for the different invitation intervals. Out of all individuals that previously tested negative, 84 (0.004%) had an interval CRC beyond the 24 months since their last invitation. The time period of invitation as well as the extended invitation interval was not associated with detection rates for AN and interval CRC rate. CONCLUSION: The impact of the first COVID-19 wave on screening yield was modest. A very small proportion of the FIT negatives had an interval CRC possibly due to an extended interval, which potentially could have been prevented if they had received the invitation earlier. Nonetheless, no increase in interval CRC rate was observed, indicating that an extended invitation interval up to 30 months had no negative impact on the performance of the CRC screening programme and a modest extension of the invitation interval seems an appropriate intervention.