Abstract
On March 19, 2020, the governor of California issued a statewide stay-at-home order to contain the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* The order reduced accessibility to and patient attendance at outpatient medical visits,† including preventive services such as cervical cancer screening. In-person clinic visits increased when California reopened essential businesses on June 12, 2020.§ Electronic medical records of approximately 1.5 million women served by Kaiser Permanente Southern California (KPSC), a large integrated health care system, were examined to assess cervical cancer screening rates before, during, and after the stay-at-home order. KPSC policy is to screen women aged 21-29 years every 3 years with cervical cytology alone (Papanicolaou [Pap] test); those aged 30-65 years were screened every 5 years with human papillomavirus (HPV) testing and cytology (cotesting) through July 15, 2020, and after July 15, 2020, with HPV testing alone, consistent with the latest recommendations from U.S. Preventive Services Task Force.¶ Compared with the 2019 baseline, cervical cancer screening rates decreased substantially during the stay-at-home order. Among women aged 21-29 years, cervical cytology screening rates per 100 person-months declined 78%. Among women aged 30-65 years, HPV test screening rates per 100 person-months decreased 82%. After the stay-at-home order was lifted, screening rates returned to near baseline, which might have been aided by aspects of KPSC's integrated, organized screening program (e.g., reminder systems and tracking persons lost to follow-up). As the pandemic continues, groups at higher risk for developing cervical cancers and precancers should be evaluated first. Ensuring that women receive preventive services, including cancer screening and appropriate follow-up in a safe and timely manner, remains important.
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approximately 80% compared with baseline
Summary
This study examined cervical cancer screening rates in women before the stay-at-home order (January 1–March 18, 2020), during the stay-at-home order (March 19–June 11, 2020), and after the stay-at-home order was lifted (June 12– September 30, 2020), compared with the same periods during January 1–September 30, 2019. Electronic medical records of women aged 21–65 years who were enrolled KPSC members for ≥1 day during this period were examined. KPSC membership enrollment was stable, with similar age group and race/ ethnicity distributions in both periods (Table 1). Among women aged 21–29 years, screening rates in 2020 were 8% lower before the stay-at-home order, 78% lower during the stay-at-home order, and 29% lower after the stayat-home order was lifted compared with rates during 2019.
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