Increased disparities in cervical cancer screening associated with the COVID-19 pandemic (436)

Abstract

Objectives: To evaluate the impact of the COVID-19 pandemic on women’s preventative healthcare with regards to cervical cancer screening.Methods: This retrospective chart review evaluated a randomized selection of women scheduled to present to a single referral-based colposcopy clinic from February 2020-January 2021 (COVID group) compared to those scheduled the year prior (pre-COVID group). Inclusion criteria included females aged >21 years, with an appropriate referral for colposcopy. Patients were grouped into three categories: (1) ADHERENT to follow-up if they came to their scheduled appointment; (2) DELAYED if they presented more than three months from their original referral (usually missing 1-3 appointments); and (3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26.Results: A total of 312 women met the inclusion criteria for the study and were randomly selected; 237 in the pre-COVID group and 77 in the COVID group. During the study period of February 2020-January 2021, our institution saw a 39.5% decrease in patients presenting for their scheduled colposcopy appointment. Within the COVID group, 71.2% were NOT ADHERENT or DELAYED in their care compared with 57.4% in the pre-COVID group (p=0.0001). There were no major differences in race, age, or Pap abnormality between the groups. The majority of women were Black (65.2%) followed by non-Hispanic Whites (20.0%) and Latinx (14.8%). In the pre-COVID group, Black women were more likely to be NOT ADHERENT (45.6%; p=0.02), and Hispanic women had the highest rate of DELAYED presentation (28.1%; p=0.01). In the COVID group, all races and ethnicities had a higher percentage of being NOT ADHERENT (Black 47.7%, White 61.5%, and Hispanic 42.9%) compared with the pre-COVID group (Black 46.6%, White 35.6%, and Hispanic 15.6%). Overall, 81.8% of Black women were either DELAYED or NOT ADHERENT during COVID compared with 61.5% and 50.0% of White and Hispanic women, respectively (p<0.001).Conclusions: In general, there is a concerning gap in care with women who do not follow-up for treatment after having an abnormal Pap test. The COVID-19 pandemic had a substantial effect on women’s access to care with regards to all races and ethnicities in this study, where nearly two-thirds of women were DELAYED or NOT ADHERENT to care. However, the greatest difference was seen with Black women who were adherent less than 20% of the time. Moving forward, it is crucial to provide a culturally relevant assessment of barriers to care and targeted interventions to narrow the gap and reach these women who were lost to care.