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.
Highlights
In the United States, in 2020, an estimated 13,800 women developed cervical cancer (CC) and over 4290 died from CC.[1]
As the primary screening modality varies in the United States, we explored the impact of screening delays in the context of primary cytology (i.e. Pap smear only) with and without switching to primary cytology and high-risk human papillomavirus (HPV) “cotesting” at age 30
Projected disruptions yielded greater net increases in cases for cytology-based compared with cotesting-based screening, for 24-month disruptions compared with 6-month disruptions, and when all screening process steps were disrupted compared with only primary screening
Summary
In the United States, in 2020, an estimated 13,800 women developed cervical cancer (CC) and over 4290 died from CC.[1] The natural history of CC is amenable to screening, which aims to detect the presence of high-grade precancers that can be treated before progressing to cancer or to detect invasive cancer earlier. Secondary impacts of the COVID-19 pandemic on preventive health care, such as CC screening, are largely unknown. Certain provider networks in the United States have reported 80% reductions in screening rates during periods of disruption,[2] which is similar to other areas of the United States.[3] Sustained disruptions may contribute to poor outcomes for individuals unable to access usual care.
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