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1.
Cytopathology ; 33(3): 350-356, 2022 May.
Article in English | MEDLINE | ID: covidwho-1577413

ABSTRACT

BACKGROUND: The coronavirus pandemic has had a profound impact on the cervical screening programme in Wales for the eligible women, sample takers, and laboratory and colposcopy services. AIMS: To explore what changes due to the pandemic have adversely affected screening outcomes in Wales and what lessons can be learned to improve cervical screening in Wales and elsewhere. METHODS: A review of the screening performance in 2020 and the first quarter of 2021 in Wales as well as a comparison with other cervical screening programme responses to the pandemic. RESULTS: A 3 month pause of screening together with a change in a variety of working practices, including social distancing, use of personal protective equipment, use of virtual meetings, and home working have been implemented. The combination of a pause to the issuing of invitations, plus reduced services in primary and secondary care, together with population lockdown, have contributed to longer waiting times for colposcopy and potentially delayed cancer diagnoses. Some programme changes which were being evaluated prior to the pandemic could be developed now to mitigate the impact of the pandemic such as improved information, increased screening intervals for human papillomavirus-based screening programmes, and home working for call and recall staff. CONCLUSIONS: Despite a considerable short-term interruption to the cervical screening programme, some changes introduced as a result of the coronavirus pandemic could provide key lessons learnt for improvement for cervical cancer prevention services.


Subject(s)
Cervical Intraepithelial Neoplasia , Coronavirus Infections , Coronavirus , Papillomavirus Infections , Uterine Cervical Neoplasms , Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics/prevention & control , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Pregnancy , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears
2.
BJOG ; 128(9): 1503-1510, 2021 08.
Article in English | MEDLINE | ID: covidwho-1315738

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 of 21-69 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 6 months of the COVID-19 pandemic (March-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 6 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 to -41.0%), 39.7% (range: -75.1 to -14.3%) and 31.1% (range: -43.5 to -23.6%), respectively, when compared with 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, 1159 (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 utilisation 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. TWEETABLE ABSTRACT: COVID-19 has had a substantial impact on cervical screening and follow-up services in Ontario, Canada.


Subject(s)
COVID-19/prevention & control , Colposcopy/statistics & numerical data , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy , Vaginal Smears/statistics & numerical data , Adult , Aged , Databases, Factual , Delivery of Health Care/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Female , Humans , Middle Aged , Ontario , SARS-CoV-2 , Young Adult
3.
PLoS One ; 16(7): e0253493, 2021.
Article in English | MEDLINE | ID: covidwho-1298079

ABSTRACT

OBJECTIVE: To validate the colposcopy indication proposed by the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests (the 2019 ASCCP guidelines). METHODS: Clinical data of 1404 patients who underwent colposcopy in single center in China were reviewed. Based on history and current cervical screening (HPV & cytology), corresponding recommendations were given according to the 2019 ASCCP guidelines. The agreement and discrepancy of colposcopy indication were analyzed between the Chinese consensus and the 2019 ASCCP guidelines. RESULTS: Colposcopy indication was matched in about 80% patients. The left 20% were recommended with follow-up by the 2019 ASCCP guidelines. The discrepancy mainly focused on patients having a current result of HPV-positive NILM without unknown history. The ratio of observed CIN3+ in our database over estimated CIN3+ by the 2019 ASCCP guidelines was 6.2 (31/5). The ratio was even higher in patients with HPV16/18-positive NILM (7, 28/4), compared with those with other types of high-risk HPV-positive NILM (3, 3/1). The 2019 ASCCP guidelines had a relatively high sensitivity (83.1%), a low specificity (21.5%), a low positive predictive value (14.1%) and a high negative predictive value (89.1%) for prediction of CIN 3+. CONCLUSIONS: We could try to apply the 2019 ASCCP guidelines in Chinese population. The classification of HR-HPV was strongly recommended during risk assessment. For patients with HPV16/18 infection, colposcopy should be recommended. Perspective multi-center randomized controlled trial with reliable follow-up should be performed in the future to confirm the feasibility.


Subject(s)
Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy/standards , Early Detection of Cancer/methods , Guidelines as Topic , Uterine Cervical Neoplasms/diagnosis , Adult , Cervical Intraepithelial Neoplasia/pathology , China , Female , Human papillomavirus 16/isolation & purification , Human papillomavirus 18/isolation & purification , Humans , Mass Screening/methods , Papillomavirus Infections/pathology , Retrospective Studies , Risk , Uterine Cervical Neoplasms/pathology
5.
Womens Health (Lond) ; 17: 17455065211017070, 2021.
Article in English | MEDLINE | ID: covidwho-1242233

ABSTRACT

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented upheaval within global healthcare systems and resulted in the temporary pausing of the National Health Service (NHS) Scotland Cervical Screening Programme. With several months of backlogs in appointments, there has not only been a reduction in primary samples being taken for human papilloma virus (HPV) testing but there have also been fewer women referred to colposcopy for investigation and treatment of precancerous or cancerous changes as a result. Encouraging uptake for cervical screening was always a priority before the pandemic, but it is even more important now, considering that the fears and barriers to screening that women may have are now exacerbated by COVID-19. OBJECTIVES: This article explores the impact of the pandemic on the uptake of cervical screening within NHS Ayrshire & Arran and evaluates potential strategies to improve uptake now and in future such as self-sampling and telemedicine. METHODS: This article presents evidence-based literature and local health board data relating to cervical screening during the pandemic. RESULTS: Human papilloma virus self-sampling carried out by the woman in her home has been shown to improve uptake, especially in non-attenders, whilst maintaining a high sensitivity and, crucially, reducing the need for face-to-face contact. Increased education is key to overcoming barriers women have to screening and telemedicine can strengthen engagement with women during this time. CONCLUSION: There are lessons to be learned from the pandemic, and we must use this opportunity to improve cervical screening uptake for the future.


Subject(s)
Early Detection of Cancer/methods , Mass Screening/methods , Mass Screening/statistics & numerical data , Papillomaviridae , Self Care , Uterine Cervical Neoplasms/prevention & control , Adult , Appointments and Schedules , COVID-19/epidemiology , Cervical Intraepithelial Neoplasia/prevention & control , Colposcopy , Female , Humans , Middle Aged , Papanicolaou Test , Scotland/epidemiology , Vaginal Smears
6.
BJOG ; 128(9): 1503-1510, 2021 08.
Article in English | MEDLINE | ID: covidwho-1226637

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 of 21-69 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 6 months of the COVID-19 pandemic (March-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 6 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 to -41.0%), 39.7% (range: -75.1 to -14.3%) and 31.1% (range: -43.5 to -23.6%), respectively, when compared with 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, 1159 (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 utilisation 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. TWEETABLE ABSTRACT: COVID-19 has had a substantial impact on cervical screening and follow-up services in Ontario, Canada.


Subject(s)
COVID-19/prevention & control , Colposcopy/statistics & numerical data , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy , Vaginal Smears/statistics & numerical data , Adult , Aged , Databases, Factual , Delivery of Health Care/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Female , Humans , Middle Aged , Ontario , SARS-CoV-2 , Young Adult
7.
J Med Screen ; 28(2): 213-216, 2021 06.
Article in English | MEDLINE | ID: covidwho-1140458

ABSTRACT

OBJECTIVES: To quantify the secondary impacts of the COVID-19 pandemic disruptions to cervical cancer screening in the United States, stratified by step in the screening process and primary test modality, on cervical cancer burden. METHODS: We conducted a comparative model-based analysis using three independent NCI Cancer Intervention and Surveillance Modeling Network cervical models to quantify the impact of eight alternative COVID-19-related screening disruption scenarios compared to a scenario of no disruptions. Scenarios varied by the duration of the disruption (6 or 24 months), steps in the screening process being disrupted (primary screening, surveillance, colposcopy, excisional treatment), and primary screening modality (cytology alone or cytology plus human papillomavirus "cotesting"). RESULTS: The models consistently showed that COVID-19-related disruptions yield small net increases in cervical cancer cases by 2027, which are greater for women previously screened with cytology compared with cotesting. When disruptions affected all four steps in the screening process under cytology-based screening, there were an additional 5-7 and 38-45 cases per one million screened for 6- and 24-month disruptions, respectively. In contrast, under cotesting, there were additional 4-5 and 35-45 cases per one million screened for 6- and 24-month disruptions, respectively. The majority (58-79%) of the projected increases in cases under cotesting were due to disruptions to surveillance, colposcopies, or excisional treatment, rather than to primary screening. CONCLUSIONS: Women in need of surveillance, colposcopies, or excisional treatment, or whose last primary screen did not involve human papillomavirus testing, may comprise priority groups for reintroductions.


Subject(s)
COVID-19 , Early Detection of Cancer , Uterine Cervical Neoplasms/diagnosis , Adult , Colposcopy , Cytological Techniques , Female , Humans , Middle Aged , Models, Statistical , Papillomaviridae/isolation & purification , Papillomavirus Infections/diagnosis , United States , Uterine Cervical Neoplasms/epidemiology
8.
Future Oncol ; 17(10): 1197-1207, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1112570

ABSTRACT

Aims: To evaluate the efficacy of TruScreen (TS01) for high-risk human papillomavirus (HR-HPV) women compared with other methods in reducing colposcopy referral rates in hospitals. Methods: A single-center, prospective, case-control study was conducted from December 2019 to June 2020. Results: Among 139 (46.2%) HR-HPV-positive patients, 58 were CIN1, 52 were CIN2-3 and 29 had cervical cancer (n = 29). The sensitivity and specificity of detecting CIN2+ by TS01, colposcopy and HPV16/18 testing were 96.3% and 46.4%, 85.2% and 40.5% and 59.3% and 74.1%, respectively. The highest sensitivity was 96.3% at HPV16/18 and TS01 (each positive results), and the highest specificity was 83.6% at HPV16/18 and TS01 (both positive) for CIN2+ compared with the other methods. Conclusion: TS01 is a noninvasive screening method and can be used to diagnose cervical lesions quickly. It is especially suitable as triage tool for HR-HPV-positive women facing SARS-CoV-2 exposure and infection risks in hospital.


Subject(s)
COVID-19/epidemiology , Cervical Intraepithelial Neoplasia/diagnosis , Early Detection of Cancer/methods , Papillomavirus Infections/complications , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Colposcopy , Female , Humans , Middle Aged , Prospective Studies , Sensitivity and Specificity , Triage/methods , Young Adult
9.
Br J Cancer ; 124(8): 1361-1365, 2021 04.
Article in English | MEDLINE | ID: covidwho-1072147

ABSTRACT

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.


Subject(s)
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
10.
Ginekol Pol ; 91(7): 428-431, 2020.
Article in English | MEDLINE | ID: covidwho-719820

ABSTRACT

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence.


Subject(s)
Cervical Intraepithelial Neoplasia , Cervix Uteri/pathology , Colposcopy , Coronavirus Infections , Early Detection of Cancer , Pandemics , Pneumonia, Viral , Uterine Cervical Neoplasms , Betacoronavirus , COVID-19 , Cervical Intraepithelial Neoplasia/diagnosis , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/methods , Colposcopy/standards , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Diagnosis, Differential , Early Detection of Cancer/standards , Female , Humans , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Poland/epidemiology , SARS-CoV-2 , Secondary Prevention/methods , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
12.
Int J Gynecol Cancer ; 30(8): 1097-1100, 2020 08.
Article in English | MEDLINE | ID: covidwho-505825
13.
Int J Gynaecol Obstet ; 149(3): 269-272, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-47598

ABSTRACT

In the context of the COVID-19 pandemic, patients need to be evaluated within 2-4 weeks in the following cases: cytology result of "squamous cell carcinoma," "atypical glandular cells, favor neoplastic," "endocervical adenocarcinoma in situ," or "adenocarcinoma"; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.


Subject(s)
Ambulatory Surgical Procedures/standards , Colposcopy/standards , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Genital Diseases, Female/surgery , Infection Control/standards , Pandemics , Pneumonia, Viral , Adult , Biopsy , COVID-19 , Consensus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Genital Diseases, Female/diagnosis , Genital Diseases, Female/pathology , Humans , Italy , Mass Screening , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Pregnancy , Time Factors
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