Abstract
BackgroundThe COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened.MethodsUsing routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25–49 and 5 years at ages 50–64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay.ResultsBoth scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities—they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000).ConclusionTo ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.
Highlights
The COVID-19 pandemic has disrupted cervical cancer screening services
14,677,008 14,677,008 10,699,491c 1,522,219d aScenario 1 considers a rolling delay of 6 months for all women in England over one screening cycle. bScenario 2 assumes women who experience COVID-19-related disruptions to screening have a 36- or 60-month delay to their screening. cWomen who undergo screening in one screening round of 3 or 5 years, depending on age, estimated from the NHS Cervical Screening Programme statistics for years 2018–2019. dWomen who undergo screening during a period of 6 months, estimated from the NHS Cervical Screening Programme statistics for years 2018–2019
Any delays to cervical screening will negatively impact cancer diagnoses. Both scenarios modelled here resulted in ~630 excess cancers, equivalent to just over 4 per 100,000 women in the population, distributed across one round of screening (i.e. 3 or 5 years depending on age)
Summary
The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened. METHODS: Using routine statistics from England we estimate the number of women affected by delays to screening. We estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages [25–49] and 5 years at ages [50–64] years). 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay. The scenario in which some women miss one screening cycle creates inequalities—they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000). Screening has been offered to women aged [25–49] years at 3-yearly intervals ( the plan is to extend to 5-yearly with HPV testing) and to those aged [50–64] years at 5-yearly intervals. The European age-standardised incidence of cervical cancer in England for women aged [25–64] years has been hovering ~9.5/ 100,000.1
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