The impact of the COVID-19 pandemic on endometrial cancer and endometrial hyperplasia diagnoses: a population-based study

Abstract

Endometrial cancer is the most common gynecologic malignancy in high-income countries, and most cases arise from a precursor lesion, endometrial hyperplasia. During the COVID-19 pandemic, many professional bodies advised a suspension in gynecologic services, except for urgent care,1Thomas V. Maillard C. Barnard A. et al.International Society for Gynecologic Endoscopy (ISGE) guidelines and recommendations on gynecological endoscopy during the evolutionary phases of the SARS-CoV-2 pandemic.Eur J Obstet Gynecol Reprod Biol. 2020; 253: 133-140Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar,2Royal College of Obstetricians and Gynaecologists, British Society for Gynaecological Endoscopy, British Gynaecological Cancer SocietyJoint RCOG, BSGE and BGCS guidance for the management of abnormal uterine bleeding in the evolving coronavirus (COVID-19) pandemic. Royal College of Obstetricians & Gynaecologists.https://www.rcog.org.uk/globalassets/documents/guidelines/2020-05-21-joint-rcog-bsge-bgcs-guidance-for-management-of-abnormal-uterine-bleeding-aub-in-the-evolving-coronavirus-covid-19-pandemic-updated-final-180520.pdfDate: 2020Google Scholar to reduce COVID-19 transmission and optimize limited human and physical resources. In the United Kingdom, remote management of abnormal uterine bleeding, the major presenting symptom of endometrial cancer and endometrial hyperplasia, was recommended, with referral to secondary care only in urgent cases.2Royal College of Obstetricians and Gynaecologists, British Society for Gynaecological Endoscopy, British Gynaecological Cancer SocietyJoint RCOG, BSGE and BGCS guidance for the management of abnormal uterine bleeding in the evolving coronavirus (COVID-19) pandemic. Royal College of Obstetricians & Gynaecologists.https://www.rcog.org.uk/globalassets/documents/guidelines/2020-05-21-joint-rcog-bsge-bgcs-guidance-for-management-of-abnormal-uterine-bleeding-aub-in-the-evolving-coronavirus-covid-19-pandemic-updated-final-180520.pdfDate: 2020Google Scholar This contradicted the established Royal College of Obstetricians and Gynaecologists’ guidelines, which advised hysteroscopy and/or endometrial biopsy within 4 weeks for diagnosis of suspected endometrial hyperplasia or cancer.3Royal College of Obstetricians and GynaecologistsRestoration and recovery: priorities for obstetrics and gynaecology. A prioritisation framework for care in response to COVID-19. Royal College of Obstetricians and Gynaecologists.https://www.rcog.org.uk/globalassets/documents/guidelines/2021-04-20-restoration-and-recovery---priorities-for-obstetrics-and-gynaecology.pdfDate: 2021Google Scholar We described the impact of the COVID-19 pandemic on pathologic diagnoses of endometrial cancer and endometrial hyperplasia within population-based databases in Northern Ireland. The Northern Ireland Cancer Registry is a population-based register covering 1.9 million inhabitants.4Kearney T.M. Donnelly C. Kelly J.M. O’Callaghan E.P. Fox C.R. Gavin A.T. Validation of the completeness and accuracy of the Northern Ireland Cancer Registry.Cancer Epidemiol. 2015; 39: 401-404Crossref PubMed Google Scholar Electronic pathology reports were used to identify unique patients diagnosed with endometrial cancer or endometrial hyperplasia between March 1, 2020, and December 31, 2020 (the initial stages of the COVID-19 pandemic when “lockdown” was introduced at various times). Data were compared with the average number of histopathologically confirmed cases during the same months between 2017 and 2019. Further information is available in the Supplemental Methods. The number of endometrial cancer diagnoses declined by 19.1% between March 2020 and December 2020 compared with the equivalent months from 2017 to 2019 (Figure). There was some evidence of recovery in winter months, with diagnoses in October and November returning to expected levels (Supplemental Figure). Overall, 70 fewer endometrial cancer cases than expected were diagnosed from March 2020 to December 2020. The number of atypical hyperplasia and hyperplasia without atypia diagnoses declined by 35.2% and 43.5%, respectively, compared with the data from 2017 to 2019 (Figure). Data were limited to indicate recovery in winter months (Supplemental Figure). There were 40 and 20 fewer cases of hyperplasia without atypia and atypical hyperplasia, respectively, than expected between March 2020 and December 2020. We demonstrated a marked reduction in pathologic diagnoses of endometrial cancer and endometrial hyperplasia during the first 10 months of the COVID-19 pandemic. Although endometrial cancer diagnoses showed signs of recovery, endometrial hyperplasia diagnosis continued to lag behind expected rates, likely because of the reprioritization of gynecologic services.3Royal College of Obstetricians and GynaecologistsRestoration and recovery: priorities for obstetrics and gynaecology. A prioritisation framework for care in response to COVID-19. Royal College of Obstetricians and Gynaecologists.https://www.rcog.org.uk/globalassets/documents/guidelines/2021-04-20-restoration-and-recovery---priorities-for-obstetrics-and-gynaecology.pdfDate: 2021Google Scholar