The Impact of COVID-19 on Cervical Cancer Screenings and Clinical Outcomes of Patients: A Single-Center Tertiary Healthcare Service Experience

Abstract

Objective: The COVID-19 pandemic has negatively affected cancer screening activities all over the World. The accumulating data suggest that delayed admissions to screening and clinical assessments are associated with increased morbidity and mortality in cancer. This study aimed to provide data on cervical cancer screenings and clinical outcomescomparatively before and during the pandemic. Method: This study retrospectively compared the demographic and clinical characteristics, screening test results, andcolposcopy assessments of women admitted to the Obstetrics and Gynecology Department of a tertiary-care university hospital before and after March 11, 2020, considered as the date of announcement of the COVID-19 pandemic. Results: A total of 382 patients with a median age of 32 years were included (174 in pre-pandemic and 208 in pandemic periods).In HPV DNA analyses, serotypes reported as high-risk were significantly increased to 22.1%, while others had minor changes in the pandemic. In cytological studies, normal cytology results were significantly decreased to 32.8% from 45.9%, and the ASC-US diagnoses were significantly increased from 12.8% to 27.4%. In addition, the colposcopy examinations revealed that the cold knife cone was increased from zero to 15.3%, routine follow-up was decreased from 88.2% to 71.4%, normal pathologies were decreased from 40.4% to 30.1%, and CIN1 and CIN2 decreased, but CIN3 rose from 3.6% to 6.6%. The HPV DNA and colposcopy follow-up were significantly increased during the pandemic. Conclusions: This study is the first report on the increased numbers of diagnoses of advanced lesions in cervical cancer screenings during the pandemic compared to the pre-pandemic admissions in Turkey. Our results implythe need for immediate actions to normalize cervical cancer screenings to avoid any further morbidity and mortality. High-risk HPV-DNA results in the Covid period were found to be higher than before the Covid period. Keywords: Cervical cancer, screening, cervical smear, cytology, colposcopy, clinical outcomes, COVID-19, pandemic, Turkey