Delays in LEEP associated with the COVID-19 pandemic and impact on resulting pathology

Abstract

Objectives:Over the course of the past year, medical providers were forced to make difficult decisions in response to the global COVID-19 pandemic. Many clinics were closed for routine and follow-up visits in order to preserve personal protective equipment and to decrease exposure of patients and staff to the virus. The aim of this study was to assess the effect that the COVID-19 response had on scheduling a loop electrosurgical excision procedure (LEEP) and the potential impact on resulting pathology.Methods:A retrospective review of all patients who received a LEEP due to an abnormal cervical cancer screening test at a single inner-city academic institution was performed. Procedures scheduled from March 2020 (start of the COVID-19 pandemic) through July 2020 were included. Baseline patient characteristics (including race), time from colposcopy to LEEP, and pathology results were collected.Results:A total of 37 patients underwent a LEEP in this timeframe. Median age was 33 years (range, 22-63) and 6 patients (16%) were smokers. Median time between colposcopy and LEEP was 80 days (range, 0-303 days), with 25% having a delay of ≥131.5 days. Non-White patients (n=25, median 91 days) experienced numerically higher delays than White patients (n=12, median 34.5 days, p=0.077, Mann-Whitney U test). Expedited treatment (colposcopy and LEEP on same day) occurred in 0/25 non-White patients and in 3/12 White patients (p=0.028, Fisher exact test). On colposcopy, 31/37 patients (84%) had high grade squamous intraepithelial lesion (HSIL); the rest had low grade squamous intraepithelial lesion (LSIL) or lower. On LEEP, 1 patient had squamous cell carcinoma (3%) and 20 patients had HSIL (54%); the rest had LSIL or lower. From colposcopy to LEEP, 14/37 patients (37.8%) had discordant pathologies of which 2 patients (5%) had upgraded pathologies; these two patients underwent LEEP 136 days and 142 days after colposcopy and were upgraded to squamous cell carcinoma and HSIL, respectively. A total of 12 patients (32.4%) had downgraded pathologies.Conclusions:During the COVID-19 pandemic, a large proportion of inner-city patients experienced delays between colposcopy and LEEP, an effect which seemed more pronounced among non-White patients. The patients with upgraded interval pathologies had particularly long delays between the procedures. Additional study is needed to examine the potential negative ramifications of the COVID-19 pandemic on cervical cancer screening and healthcare disparities.