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1.
Medwave ; 22(10): e2589, 2022 Nov 07.
Article in English, Spanish | MEDLINE | ID: covidwho-2144874

ABSTRACT

Introduction: Cervical cancer is the second most frequent malignant disease in the Peruvian female population, and the Papanicolaou test is its main screening tool. However, the COVID-19 pandemic can hinder cervical cancer screening, reducing its scope. Objective: To analyze the decline of Papanicolaou-based cervical cancer screening due to COVID-19 in a specialized hospital in Lima. Methods: We designed a retrospective study (from 2015 to 2020) on 355 029 Papanicolaou smears at the Hospital Nacional Madre Niño San Bartolomé. T-test and one-way ANOVA were used to define differences in the study period and Ljung-Box test with ARIMA (1,0,0) model to describe and forecast monthly expected Papanicolaou smears for 2020. Results: Throughout the six years of the study, the average Papanicolaou smears was 59 171.5 ± 8898.7 per year. However, in 2020 only 16 273 (4.58%) Papanicolaou tests were performed with a monthly mean of 1356.1 ± 684.2 (95% confidence interval 149.7 to 2861.9) (p < 0.001). The forecast showed 66 960 Papanicolaou smears for 2020 and a monthly mean of 5580 ± 129.3. Actual screenings during that year were only 16 273 Papanicolaou smears, resulting in a 76.7% reduction in cervical cancer screening during the pandemic. Conclusions: Our results suggest a dramatic decrease in cervical cancer screening based on Papanicolaou smears during 2020 in Peru due to prevention and control measures against COVID-19.


Introducción: El cáncer de cuello uterino es la segunda neoplasia más frecuente en la población femenina peruana y la prueba de Papanicolau es la principal estrategia de cribado. Sin embargo, la pandemia de COVID-19 puede bloquear el tamizaje cervicovaginal pudiendo reducir su alcance. Objetivo: Analizar el declive del cribado de cáncer de cuello uterino basado en la prueba de Papanicolaou, debido a COVID-19 en un hospital especializado de Lima. Métodos: Diseñamos un estudio retrospectivo (de 2015 a 2020) en 355 029 pruebas de Papanicolau en el Hospital Nacional Madre Niño San Bartolomé. Se utilizó la prueba T y ANOVA para definir las diferencias en el periodo del estudio y la prueba de Ljung-Box con modelo ARIMA (1,0,0) para describir y pronosticar mensualmente las pruebas de Papanicolau esperadas para el año 2020. Resultados: Durante los seis años del estudio el promedio fue de 59 171,5 ± 8898,7 pruebas de Papanicolau por año. Sin embargo, en 2020 solo se realizaron 16 273 (4,58%) pruebas de Papanicolau con una media mensual de 1356,1 ± 684,2 (intervalo de confianza 95%: 149,7 a 2861,9) (p < 0,001). El pronóstico mostró 66 960 pruebas de Papanicolau para el año 2020 y una media mensual de 5580 ± 129,3. Los tamizajes reales durante ese año fueron solamente de 16 273 pruebas de Papanicolau , generando un 76,7% de reducción del tamizaje de cáncer de cuello uterino durante la pandemia. Conclusiones: Conclusiones.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , Female , Humans , Early Detection of Cancer , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , COVID-19/diagnosis , Peru/epidemiology , Pandemics , Retrospective Studies
2.
N Z Med J ; 135(1565): 83-94, 2022 Nov 11.
Article in English | MEDLINE | ID: covidwho-2112071

ABSTRACT

AIM: To determine the feasibility and acceptability of a telehealth offer and contactless delivery of human papillomavirus (HPV) cervical screening self-test during the 2021 COVID-19 Level 4 lockdown in Auckland, New Zealand. METHODS: A small proof-of-concept study was undertaken to test telehealth approaches in never-screened, due or overdue Maori and Pacific women enrolled in a local Primary Health Organisation (PHO). Study invitation, active follow-up, nurse-led discussions, result notification and a post-test questionnaire were all delivered through telehealth. RESULTS: A sample of 197 eligible Maori and Pacific women were invited to take part, of which 86 women were successfully contacted. Sixty-six agreed to take part. Overall uptake was 61 samples returned (31.8%) and uptake of all contactable women was 70.9%. Six of the 61 HPV self-tests (9.8%) were positive, all for non 16/18 types, and were referred for cytology. Three had negative cytology results, and three with positive cytology results were referred for colposcopy. CONCLUSION: The offer of HPV self-testing during COVID-19 lockdown was both feasible and highly acceptable for Maori and Pacific women. Importantly, HPV self-testing via telehealth and mail-out, alongside other options, offers a potential pro-equity approach for addressing the impact of deferred screens due to COVID-19 and other longstanding coverage issues.


Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Telemedicine , Uterine Cervical Neoplasms , Female , Humans , Pregnancy , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/epidemiology , Self-Testing , Early Detection of Cancer/methods , Native Hawaiian or Other Pacific Islander , Feasibility Studies , COVID-19/diagnosis , COVID-19/epidemiology , New Zealand/epidemiology , Communicable Disease Control , Papillomaviridae , Colposcopy , Mass Screening , Disease Outbreaks , Vaginal Smears
3.
Asian Pac J Cancer Prev ; 23(5): 1497-1504, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-2100936

ABSTRACT

OBJECTIVE: A systematic review and meta-analysis were carried out to assess the pooled proportion of women screened for cervical cancer before and during the COVID-19 pandemic. METHODS: After ruling out registered or ongoing systematic reviews in the PROSPERO database regarding the impact of the COVID-19 pandemic in cervical cancer screening, the protocol of our systematic review and meta-analysis was registered in PROSPERO (CRD42021279305). The electronic databases were searched for articles published in English between January 2020 and October 2021and the study was designed based on PRISMA guidelines updated in 2020. Meta-analysis was accomplished in STATA version 13.0 (College Station, Texas 77,845 USA). The pooled proportion of women who had undergone cervical cancer screening was reported with 95% CI. In order to quantify the heterogeneity, Chi2 statistic (Q statistic) and I2 index were used. RESULTS: The meta-analysis included seven studies from Slovenia, Italy, Ontario (Canada), Scotland, Belgium, and the USA, comprising 403,986 women and 199,165 women who were screened for cervical cancer before the COVID-19 pandemic in 2019 and during the pandemic in 2020, respectively. The pooled proportion of women screened for cervical cancer in 2019 was 9.79% (95% CI 6.00%-13.59%, 95% prediction interval 0.42%-23.81%). During the pandemic, the pooled proportion of screened women declined to 4.24% (95% CI 2.77%-5.71%, 95% prediction interval 0.9%-17.49%). CONCLUSION: There was a substantial drop in the cervical cancer screening rate due to lockdowns and travel restrictions to curb the COVID-19 pandemic. Scaling up cervical cancer screening strategies is essential to prevent the long-term impact of cervical cancer burden.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , COVID-19/diagnosis , COVID-19/epidemiology , Communicable Disease Control , Early Detection of Cancer , Female , Humans , Pandemics/prevention & control , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
4.
Elife ; 112022 10 12.
Article in English | MEDLINE | ID: covidwho-2067165

ABSTRACT

We evaluated how temporary disruptions to primary cervical cancer (CC) screening services may differentially impact women due to heterogeneity in their screening history and test modality. We used three CC models to project the short- and long-term health impacts assuming an underlying primary screening frequency (i.e., 1, 3, 5, or 10 yearly) under three alternative COVID-19-related screening disruption scenarios (i.e., 1-, 2-, or 5-year delay) versus no delay in the context of both cytology-based and human papillomavirus (HPV)-based screening. Models projected a relative increase in symptomatically detected cancer cases during a 1-year delay period that was 38% higher (Policy1-Cervix), 80% higher (Harvard), and 170% higher (MISCAN-Cervix) for underscreened women whose last cytology screen was 5 years prior to the disruption period compared with guidelines-compliant women (i.e., last screen 3 years prior to disruption). Over a woman's lifetime, temporary COVID-19-related delays had less impact on lifetime risk of developing CC than screening frequency and test modality; however, CC risks increased disproportionately the longer time had elapsed since a woman's last screen at the time of the disruption. Excess risks for a given delay period were generally lower for HPV-based screeners than for cytology-based screeners. Our independent models predicted that the main drivers of CC risk were screening frequency and screening modality, and the overall impact of disruptions from the pandemic on CC outcomes may be small. However, screening disruptions disproportionately affect underscreened women, underpinning the importance of reaching such women as a critical area of focus, regardless of temporary disruptions.


Subject(s)
COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , COVID-19/epidemiology , Cervix Uteri , Early Detection of Cancer , Female , Humans , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
5.
Arthritis Res Ther ; 24(1): 211, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2038859

ABSTRACT

BACKGROUND: Systemic lupus erythematosus (SLE) is a disease that can lead to damage of multiple organs and, along with certain treatments, increase the risk of developing cancer, cardiovascular disease, diabetes, osteoporosis, and infections. Preventive services are particularly important in patients with SLE to mitigate the aforementioned risks. We aimed to evaluate the trends of preventive services utilization in patients with systemic lupus erythematosus, compared with non-SLE population. METHODS: All ≥19-year-old patients in the Lupus Midwest Network (LUMEN) registry, a population-based cohort, with SLE on January 1, 2015, were included and matched (1:1) by sex, age, race, and county to non-SLE comparators. Among both groups, we compared the rates of screenings for breast and cervical cancer, hypertension, hyperlipidemia, diabetes mellitus, and osteoporosis as well as immunizations. RESULTS: We included 440 SLE patients and 430 non-SLE comparators. The probability of breast cancer screening among women with SLE was similar to comparators (hazard ratio [HR] 1.09, 95% CI 0.85-1.39), while cervical cancer screening was lower (HR 0.75, 95% CI 0.58-0.96). Hypertension screening was higher among patients with SLE (HR 1.35, 95% CI 1.13-1.62); however, hyperlipidemia screening was similar to comparators (HR 1.16, 95% CI 0.96-1.41). Diabetes and osteoporosis screenings were more likely to be performed for SLE patients than for comparators (HR 2.46, 95% CI 2.11-2.87; and HR 3.19, 95% CI 2.31-4.41; respectively). Influenza and pneumococcal immunizations were higher among SLE patients (HR 1.31, 95% CI 1.12-1.54; and HR 2.06, 95% CI 1.38-3.09; respectively), while zoster vaccination was similar (HR 1.17, 95% CI 0.81-1.69). CONCLUSIONS: The trends of utilization of preventive services by SLE patients vary according to screening or vaccine compared with the general population. Considering these differences, we demonstrate an opportunity for improvement, particularly in cervical cancer, hyperlipidemia, and osteoporosis screenings and vaccinations.


Subject(s)
Hyperlipidemias , Hypertension , Lupus Erythematosus, Systemic , Osteoporosis , Uterine Cervical Neoplasms , Adult , Early Detection of Cancer , Female , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/epidemiology , Risk Factors , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Young Adult
6.
Prev Chronic Dis ; 19: E59, 2022 09 15.
Article in English | MEDLINE | ID: covidwho-2030273

ABSTRACT

INTRODUCTION: In 2020, the COVID-19 pandemic led to significant declines in cancer screening, including among women served by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This study examined the spatial association between state-based COVID-19 test percent positivity and proportional change in NBCCEDP screening volume. METHODS: Using the COVID-19 Diagnostic Laboratory Testing dataset, we calculated state-based monthly COVID-19 test percent positivity from July through December 2020 and categorized rates into low, medium, and high groups. We used data from 48 NBCCEDP state awardees to calculate the state-based monthly proportional change in screening volume and compared data for July-December 2020 with the previous 5-year average for those months. We categorized changes in screening volume into large decrease, medium decrease, and minimal change and created maps of the associations between variable subgroups by using bivariate mapping in QGIS. RESULTS: Bivariate relationships between COVID-19 test percent positivity and proportional change in cancer screening volume varied over time and geography. In 5 of 6 months, 4 states had high COVID-19 test percent positivity and minimal change in breast or cervical cancer screening volume; 2 states had high COVID-19 test percent positivity and minimal change in breast and cervical cancer screening volume. CONCLUSION: Some states maintained pre-COVID-19 screening volumes despite high COVID-19 test percent positivity. Follow-up research will be conducted to determine how these states differ from those with consistent decreases in screening volume and identify factors that may have contributed to differences. This information could be useful for planning to maximize NBCCEDP awardees' ability to maintain screening volume during future public health emergencies.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , COVID-19/diagnosis , COVID-19/epidemiology , Early Detection of Cancer , Female , Humans , Pandemics , Poverty , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
7.
Epidemiol Health ; 44: e2022053, 2022.
Article in English | MEDLINE | ID: covidwho-2024880

ABSTRACT

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.


Subject(s)
Breast Neoplasms , COVID-19 , Colorectal Neoplasms , Uterine Cervical Neoplasms , Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/prevention & control , COVID-19/diagnosis , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics , Republic of Korea/epidemiology , Stomach , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
8.
Sci Rep ; 12(1): 11380, 2022 07 05.
Article in English | MEDLINE | ID: covidwho-1921722

ABSTRACT

The coronavirus disease (COVID-19) pandemic significantly declined cancer screening rates worldwide. Its impact on the South Korean population is unclear, depending on socioeconomic status (SES), residence, and history of chronic disease. This study utilized data (2018-2020) from the Korean National Cancer Screening Survey, an annual cross-sectional study employing nationally representative random sampling. Cancer screening rates were defined as the proportion of the eligible population who received respective cancer screening within the last 1 year and investigated four major cancers (stomach, colorectal, breast, and cervical). Screening rates every year were compared with screening rate ratios (SRRs) and the corresponding 95% confidence intervals (CIs). Between 2019 and 2020, screening rates declined significantly by 23%, 17%, 12%, and 8% for colorectal cancer (SRR 0.77; 95% CI 0.73-0.82), stomach cancer (SRR 0.83; 95% CI 0.79-0.87), breast cancer (SRR 0.88; 95% CI 0.82-0.93), and cervical cancer (SRR 0.92; 95% CI 0.87-0.97), respectively. Regardless of cancer type, screening was significantly lower in metropolitan residents, those with higher SES, and, interestingly, those without a history of chronic diseases. The significant decline in cancer screening during the pandemic requires urgent political intervention to reduce the burden of future cancer incidence and mortality.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , COVID-19/diagnosis , COVID-19/epidemiology , Cross-Sectional Studies , Early Detection of Cancer , Female , Humans , Republic of Korea/epidemiology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
9.
JAMA Oncol ; 8(9): 1287-1293, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-1919185

ABSTRACT

Importance: Public health services, including cancer screening tests, have been affected by the onset of the COVID-19 epidemic. Objective: To investigate the pandemic's association with cancer screening worldwide. Data Sources: In this systematic review and meta-analysis, databases such as PubMed, ProQuest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021. Study Selection: Observational studies and articles that reported data from cancer registries that compared the number of screening tests performed before and during the pandemic for breast, cervical, and colorectal cancer were included. Data Extraction and Synthesis: Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated between the 2 periods to assess the change in the number of cancer screening tests performed during the pandemic. Stratified analysis was performed by geographic area, period, and type of setting. The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: The main outcome was the weighted average percentage variation in the number of screening tests performed between January and October 2020 compared with the previous period. Results: The review comprised 39 publications. There was an overall decrease of -46.7% (95% CI, -55.5% to -37.8%) for breast cancer screening, -44.9% (95% CI, -53.8% to -36.1%) for colorectal cancer screening, and -51.8% (95% CI, -64.7% to -38.9%) for cervical cancer screening during the pandemic. For all 3 cancers, a U-shaped temporal trend was identified; for colorectal cancer, a significant decrease was still apparent after May 2020 (in June to October, the decrease was -23.4% [95% CI, -44.4% to -2.4%]). Differences by geographic area and screening setting were also identified. Conclusions and Relevance: A summary estimate of the downscaling of cancer screening tests since the onset of the COVID-19 pandemic is provided in this systematic review and meta-analysis. This could be associated with an increase in the number of avoidable cancer deaths. Effective interventions are required to restore the capacity of screening services to the prepandemic level.


Subject(s)
COVID-19 , Colorectal Neoplasms , Uterine Cervical Neoplasms , COVID-19/diagnosis , COVID-19/epidemiology , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/prevention & control , Early Detection of Cancer , Female , Humans , Pandemics , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
10.
Aust N Z J Obstet Gynaecol ; 62(5): 714-719, 2022 10.
Article in English | MEDLINE | ID: covidwho-1895938

ABSTRACT

BACKGROUND: Socio-economic (SE) status is closely linked to health status and the mechanisms of this association are complex. One important adverse effect of SE disadvantage is vulnerability to cancer and cancer is a major cause of morbidity and mortality in Australia. AIMS: We aimed to estimate the effect of SE status on mortality rates from ovarian, cervical, and endometrial cancer. MATERIALS AND METHODS: National mortality data were obtained from the Australian Bureau of Statistics (ABS) for the calendar years from 2001 to 2018, inclusive. Individual deaths were grouped by the ABS Index of Relative Socio-economic Advantage and Disadvantage. Population data were obtained to provided denominators allowing calculation of mortality rates (deaths per 100 000 women aged 30-79 years). Statistical analyses performed included tabulating point-estimates of mortality rates and their changes over time and modelling the trends of rates using maximum likelihood method. RESULTS: Age-standardised mortality rates for ovarian and cervical cancer fell over the study period but increased for endometrial cancer. There was clear evidence of a SE gradient in the mortality rate for all three cancers. This SE gradient increased over the study period for ovarian and cervical cancer but remained unchanged for endometrial cancer. CONCLUSIONS: Women at greater SE disadvantage have higher rates of death from the commonest gynaecological cancers and this gradient has not reduced over the last two decades. After the COVID-19 pandemic efforts must be redoubled to ensure that Australians already at risk of ill health do not face even greater risks because of their circumstances.


Subject(s)
COVID-19 , Endometrial Neoplasms , Uterine Cervical Neoplasms , Australia/epidemiology , Endometrial Neoplasms/epidemiology , Female , Humans , Pandemics , Socioeconomic Factors , Uterine Cervical Neoplasms/epidemiology
11.
JAMA Netw Open ; 5(6): e2215490, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1877536

ABSTRACT

Importance: Health care was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased greatly, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported. Objective: To examine changes in breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening prevalence with contemporary national, population-based Behavioral Risk Factor Surveillance System (BRFSS) data. Design, Setting, and Participants: This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women aged 50-74 years), CC (women aged 25-64 years), and CRC (women and men aged 50-75 years) screening. Data analysis was performed from September 2021 to February 2022. Exposures: Calendar year. Main Outcomes and Measures: Self-reported receipt of a recent (defined as in the past year) BC, CC, and CRC screening test. Adjusted prevalence ratios (aPRs) comparing 2020 vs 2018 prevalence and 95% CIs were computed. Results: In total, 479 248 individuals were included in the analyses of BC screening, 301 453 individuals were included in CC screening, and 854 210 individuals were included in CRC screening, In 2020, among respondents aged 50 to 75 years, 14 815 (11.4%) were Black, 12 081 (12.6%) were Hispanic, 156 198 (67.3%) were White, and 79 234 (29.9%) graduated from college (all percentages are weighted). After 4 years (2014-2018) of nearly steady prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94; 95% CI, 0.92-0.96), and CC screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91). The magnitude of these decreases was greater in people with lower educational attainment and Hispanic persons. CRC screening prevalence remained steady; past-year stool testing increased by 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95% CI, 0.82-0.88) between 2018 and 2020. Conclusions and Relevance: In this survey study, stool testing increased and counterbalanced a decrease in colonoscopy during 2020, and BC and CC screening modestly decreased. How these findings might be associated with outcomes is not yet known, but they will be important to monitor, especially in populations with lower socioeconomic status, who experienced greater screening decreases during the COVID-19 pandemic.


Subject(s)
Breast Neoplasms , COVID-19 , Colorectal Neoplasms , Uterine Cervical Neoplasms , Behavioral Risk Factor Surveillance System , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Early Detection of Cancer , Female , Humans , Male , Occult Blood , Pandemics , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
12.
Epidemiol Health ; 44: e2022051, 2022.
Article in English | MEDLINE | ID: covidwho-1875951

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected every aspect of medical care. However, information regarding the impact of the pandemic on cancer screening is lacking. This study aimed to explore cancer screening changes by geographic region before and during the pandemic in Korea. METHODS: Korean National Cancer Screening Survey data for 2019 and 2020 were used. Changes in the screening rate before and during the COVID-19 pandemic were calculated by subtracting the rate in 2020 from the rate in 2019. Multivariate logistic regression analyses examined the differences in screening rates at the national and 16 provincial levels before and after the COVID-19 outbreak. RESULTS: The 1-year screening rates for the four types of cancer decreased during the pandemic (stomach cancer: -5.1, colorectal cancer: -3.8, breast cancer: -2.5, cervical cancer: -1.5%p). In metropolitan areas, the odds of undergoing screening tests during the pandemic were significantly lower than before the pandemic for stomach (adjusted odds ratio [aOR], 0.66; 95% confidence interval [CI], 0.56 to 0.76), colorectal (aOR, 0.63; 95% CI, 0.50 to 0.79), and breast cancers (aOR, 0.75; 95% CI, 0.60 to 0.94). Furthermore, the likelihood of undergoing stomach cancer screening during the pandemic was significantly lower than before the pandemic in non-metropolitan urban areas (aOR, 0.81; 95% CI, 0.70 to 0.94), while it was higher in rural areas (aOR, 1.54; 95% CI, 1.10 to 2.16). CONCLUSIONS: Since the COVID-19 pandemic, the cancer screening rate has decreased significantly, especially in large cities. Public health efforts are required to improve cancer screening rates.


Subject(s)
Breast Neoplasms , COVID-19 , Uterine Cervical Neoplasms , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Early Detection of Cancer , Female , Humans , Pandemics , Republic of Korea/epidemiology , Uterine Cervical Neoplasms/epidemiology
13.
Medicina (Kaunas) ; 58(6)2022 May 29.
Article in English | MEDLINE | ID: covidwho-1869707

ABSTRACT

Background and Objectives: Cervical cancer (CC) is the fourth most common cause of cancer-related morbidity and mortality among women worldwide. CC prevention is based on screening and HPV vaccination. The COVID-19 pandemic has caused difficulties in implementing CC-preventative measures. The aim of this study was to collect data on the implementation of CC prophylaxis in Poland provided by public and private health care with a particular focus on the impact of the COVID-19 pandemic and attempt to estimate the level of CC-screening implementation by 2026 under public and private health care. Materials and Methods: Data on the implementation of privately funded (2016-2021) and publicly funded (2014-2021) CC-preventative measures in Poland were examined. The Prophet algorithm, which positions itself as an automatic forecasting procedure and represents a local Bayesian structural time-series model, was used to predict data. The correlation test statistic was based on Pearson's product moment correlation coefficient and follows a t distribution. An asymptotic confidence interval was given based on Fisher's Z transform. Results: In 2021, a significantly higher population screening coverage was observed in private health care (71.91%) than in the public system (12.6%). Our estimation assumes that the adverse downward trend of population coverage (pap smear CC screening) in the public system will continue to 5.02% and in the private health system to 67.92% in 2026. Correlation analysis showed that with the increase in the sum of HPV tests and LBC, the percentage of Pap smear coverage in the private healthcare sector decreases r = -0.62, p = 0.260 df = 3, CI = [-0.97, 0.57]. The amount of HPV vaccinations provided in private health care is steadily increasing. Immunization coverage of the population of girls aged 9-18 years under private health care at the end of the observation period was 4.3% (2021). Conclusions: It is necessary to reorganize the public CC-screening system in Poland based on a uniform reporting system for tests performed in both public and private health care using the model of action proposed by us. We recommend the introduction of a national free HPV vaccination program funded by the government and implemented in public and private health care facilities.


Subject(s)
COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Bayes Theorem , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care , Female , Humans , Pandemics/prevention & control , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
14.
BJOG ; 129(7): 1133-1139, 2022 06.
Article in English | MEDLINE | ID: covidwho-1846145

ABSTRACT

OBJECTIVE: To review the effect of the COVID-19 pandemic on the diagnosis of cervical cancer and model the impact on workload over the next 3 years. DESIGN: A retrospective, control, cohort study. SETTING: Six cancer centres in the North of England representing a combined population of 11.5 million. METHODS: Data were collected retrospectively for all diagnoses of cervical cancer during May-October 2019 (Pre-COVID cohort) and May-October 2020 (COVID cohort). Data were used to generate tools to forecast case numbers for the next 3 years. MAIN OUTCOME MEASURES: Histology, stage, presentation, onset of symptoms, investigation and type of treatment. Patients with recurrent disease were excluded. RESULTS: 406 patients were registered across the study periods; 233 in 2019 and 173 in 2020, representing a 25.7% (n = 60) reduction in absolute numbers of diagnoses. This was accounted for by a reduction in the number of low stage cases (104 in 2019 to 77 in 2020). Adding these data to the additional cases associated with a temporary cessation in screening during the pandemic allowed development of forecasts, suggesting that over the next 3 years there would be 586, 228 and 105 extra cases of local, regional and distant disease, respectively, throughout England. Projection tools suggest that increasing surgical capacity by two or three cases per month per centre would eradicate this excess by 12 months and 7 months, respectively. CONCLUSIONS: There is likely to be a significant increase in cervical cancer cases presenting over the next 3 years. Increased surgical capacity could mitigate this with little increase in morbidity or mortality. TWEETABLE ABSTRACT: Covid will result in 919 extra cases of cervical cancer in England alone. Effects can be mitigated by increasing surgical capacity.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , COVID-19/epidemiology , Cohort Studies , England/epidemiology , Female , Humans , Pandemics , Retrospective Studies , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/pathology
15.
Am J Clin Pathol ; 157(5): 718-723, 2022 05 04.
Article in English | MEDLINE | ID: covidwho-1830964

ABSTRACT

OBJECTIVES: Extended high-risk human papillomavirus (hrHPV) genotype testing has recently been introduced in routine cervical cancer screening. Changes in national and regional hrHPV genotype prevalence offer an objective baseline indicator of the future impact of mass HPV vaccination and HPV-based cervical screening. METHODS: This retrospective study reports nationwide hrHPV genotyping results from July 2018 to June 2019 in 29 KingMed Diagnostics laboratories throughout China. RESULTS: In total, 2,458,227 hrHPV genotyping results were documented from KingMed's nationwide laboratory database during the study period. The overall prevalence of hrHPV-positive results was 19.1%, with twin peaks for highest hrHPV infection rates in women younger than 30 years of age (22.0%) and 50 years of age and older (21.8%). The most frequently detected hrHPV genotypes were HPV-52 (4.7%), HPV-16 (3.4%), HPV-53 (2.5%), HPV-58 (2.4%), HPV-51 (2.0%), and HPV-68 (1.6%). Overall, hrHPV-positive results varied regionally from 15.3% to 24.4%. CONCLUSIONS: Nationwide hrHPV genotyping results from KingMed laboratories offer a baseline for measuring the future impact of large-scale HPV vaccination. High hrHPV infection rates in older (≥50 years) Chinese women likely reflect the limited extent of cervical screening in China. High rates of hrHPV infection and variable regional hrHPV genotype distribution may represent limiting factors for cost-effective implementation of hrHPV-based cervical screening in China.


Subject(s)
Papillomavirus Infections , Uterine Cervical Neoplasms , Aged , China/epidemiology , Early Detection of Cancer/methods , Female , Genotype , Humans , Papillomaviridae/genetics , Papillomavirus Infections/epidemiology , Prevalence , Retrospective Studies , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
16.
J Low Genit Tract Dis ; 26(3): 219-222, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1831484

ABSTRACT

OBJECTIVE: The aim of the study was to estimate the impact of COVID-19 pandemic on the practice of cervical cancer screening in European countries. MATERIALS AND METHODS: A 3 rounds e-survey was conducted among the 31 European Federation for Colposcopy member countries during 2020. Each representative was asked to answer to each questionnaire for their own country. Questionnaires were not anonymous. The first questionnaire was sent in April 2020 and second and third in June and December 2020, respectively. RESULTS: Twenty five of the 31 European countries solicited responded. A total of 19 countries (70.4%) reported that screening for cervical cancer was suspended at least once during the 3 rounds of questionnaires. In addition, 11 countries reported stopping colposcopy and treatments for cervical precancerous lesions at least once during the 3 rounds of questionnaires. These situations evolved with time, with the highest rate of countries recommending suspension of screening, colposcopy, and treatments during the second round of the survey. At round 3, no country recommended screening, colposcopy, and treatment, and 12 countries (57.5%) reported normal screening was fully implemented. CONCLUSIONS: Our results suggest massive disruption in cervical cancer screening programs across Europe resulting from COVID-19 pandemic. Increase in the incidence of cervical cancer is to be expected.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , Colposcopy , Early Detection of Cancer/methods , Europe/epidemiology , Female , Humans , Mass Screening , Pandemics/prevention & control , Pregnancy , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
17.
Prev Med ; 159: 107070, 2022 06.
Article in English | MEDLINE | ID: covidwho-1799653

ABSTRACT

This invited commentary discusses the article by Richards et al. describing differences in rates of on-time HPV vaccination and cervical cancer screening in 2018 among enrollees in different insurance plans. The commentary focuses on the larger problem of low vaccination HPV rates and decreasing cervical cancer screening rates seen across all sectors. We outline challenges posed by the COVID-19 pandemic on HPV vaccination and cervical cancer screening, and discuss opportunities to improve cervical cancer prevention.


Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , COVID-19/prevention & control , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics/prevention & control , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Vaccination
18.
Front Public Health ; 10: 802947, 2022.
Article in English | MEDLINE | ID: covidwho-1779968

ABSTRACT

Human papilloma virus (HPV) is the leading cause of ano-genital cancers globally with cervical cancer as the top cause of cancer- related deaths in women. Over 90% of these deaths occur in low income countries where cancer control strategies remain inadequate. HPV vaccination provides protection against HPV types 16 and 18 which are responsible for approximately 70% of cervical cancer cases. The optimal age of vaccination is in the early adolescent period, before sexual debut with possible HPV infection. Studies have shown that children residing in low income settlements are at risk of early initiation of sexual activity. Adolescent vaccination programs would provide an avenue to link other health promotion strategies targeting this age group that has hitherto been left out of many health interventions in 2019, Kenya introduced HPV vaccine to be given to 10 year old girls. Uptake has been sub-optimal with only 33% of targeted population receiving the first dose in 2020 and 16% returning for the 2nd dose. While disruption of immunization programs by the COVID-19 pandemic contributed to the low coverage, other factors such as low demand fuelled by misinformation have also played a role.


Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , Adolescent , Child , Female , Humans , Kenya/epidemiology , Pandemics , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Vaccination
19.
J Med Screen ; 29(3): 203-208, 2022 09.
Article in English | MEDLINE | ID: covidwho-1775184

ABSTRACT

INTRODUCTION: In England, routine invitations for cervical screening were reduced between April 2020 and June 2020 due to the COVID-19 pandemic. We quantify the impact of COVID-19 disruptions on attendance and excess diagnoses of cervical cancer (CC). METHODS: Using Public Health England CC screening data on laboratory samples received in 2018 as a baseline we quantify the reduction in screening attendances due to the COVID-19 pandemic between April 2020 and March 2021 for women aged 25-64. We model the impact on excess CC diagnoses assuming once invitations resume 87.5% of women attend within 12 months and 12.5% delay screening for 3 or 5 years (depending on age). RESULTS: The number of samples received at laboratories was 91% lower than expected during April, 85% during May and 43% during June 2020 compared to the same period in 2018. Although on average laboratories received 12.6% more samples between August 2020 and April 2021 than over the same months in 2018, by April 2021 there was a short fall of 200,949 samples (6.4% fewer than in 2018). An excess of 41 CC (4.0 per 100,000 women with a maximum screening delay of 12 months) are predicted to occur among the estimated 1,024,794 women attending this screening round with a delay. An excess of 60 CC (41.0 per 100,000 women) are predicted to occur among the estimated 146,391 women who do not attend this screening round. CONCLUSION: Prompt restoration of cervical screening services limited the impact on excess CC diagnoses. However, in 2020 a 6.4% shortfall of screening samples was observed. Every effort should be made to reassure these women that services are open and safe to attend.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , COVID-19/diagnosis , COVID-19/epidemiology , Early Detection of Cancer , England/epidemiology , Female , Humans , Mass Screening , Pandemics , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control
20.
Cancer ; 128(11): 2119-2125, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1750341

ABSTRACT

BACKGROUND: Cancer-related deaths over the next decade are expected to increase due to cancer screening deficits associated with the coronavirus disease 2019 (COVID-19) pandemic. Although national deficits have been quantified, a structured response to identifying and addressing local deficits has not been widely available. The objectives of this report are to share preliminary data on monthly screening deficits in breast, colorectal, lung, and cervical cancers across diverse settings and to provide online materials from a national quality improvement (QI) study to help other institutions to address local screening deficits. METHODS: This prospective, national QI study on Return-to-Screening enrolled 748 accredited cancer programs in the United States from April through June 2021. Local prepandemic and pandemic monthly screening test volumes (MTVs) were used to calculate the relative percent change in MTV to describe the monthly screening gap. RESULTS: The majority of facilities reported monthly screening deficits (colorectal cancer, 80.6% [n = 104/129]; cervical cancer, 69.0% [n = 20/29]; breast cancer, 55.3% [n = 241/436]; lung cancer, 44.6% [n = 98/220]). Overall, the median relative percent change in MTV ranged from -17.7% for colorectal cancer (interquartile range [IQR], -33.6% to -2.8%), -6.8% for cervical cancer (IQR, -29.4% to 1.7%), -1.6% for breast cancer (IQR, -9.6% to 7.0%), and 1.2% for lung cancer (IQR, -16.9% to 19.0%). Geographic differences were not observed. There were statistically significant differences in the percent change in MTV between institution types for colorectal cancer screening (P = .02). CONCLUSION: Cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020. LAY SUMMARY: Question: How can the effects of the coronavirus disease 2019 pandemic on cancer screening be mitigated? FINDINGS: When national resources were provided, including methods to calculate local screening deficits, 748 cancer programs promptly enrolled in a national Return-to-Screening study, and the majority identified local screening deficits, most notably in colorectal cancer. Using these results, 814 quality improvement projects were initiated with the potential to add 70,000 screening tests in 2021. Meaning: Cancer screening is still in need of urgent attention, and the online resources that we provide may help to close critical screening deficits.


Subject(s)
Breast Neoplasms , COVID-19 , Colorectal Neoplasms , Lung Neoplasms , Uterine Cervical Neoplasms , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/prevention & control , Early Detection of Cancer/methods , Female , Humans , Pandemics , Prospective Studies , Quality Improvement , United States/epidemiology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
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