A model-based analysis of the health impacts of COVID-19 disruptions to primary cervical screening by time since last screen for current and future disruptions

Emily A Burger* (Corresponding Author), Inge MCM de Kok, James F O'Mahony, Matejka Rebolj, Erik EL Jansen, Daniel D de Bondt, James Killen, Sharon J Hanley, Alejandra Castanon, Mary Caroline Regan, Jane J Kim, Karen Canfell, Megan A Smith

*Corresponding author for this work

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We evaluated how temporary disruptions to primary cervical cancer (CC) screening services may differentially impact women due to heterogeneity in their screening history and test modality. We used three CC models to project the short- and long-term health impacts assuming an underlying primary screening frequency (i.e., 1, 3, 5, or 10 yearly) under three alternative COVID-19-related screening disruption scenarios (i.e., 1-, 2-, or 5-year delay) versus no delay in the context of both cytology-based and human papillomavirus (HPV)-based screening. Models projected a relative increase in symptomatically detected cancer cases during a 1-year delay period that was 38% higher (Policy1-Cervix), 80% higher (Harvard), and 170% higher (MISCAN-Cervix) for underscreened women whose last cytology screen was 5 years prior to the disruption period compared with guidelines-compliant women (i.e., last screen 3 years prior to disruption). Over a woman’s lifetime, temporary COVID-19-related delays had less impact on lifetime risk of developing CC than screening frequency and test modality; however, CC risks increased disproportionately the longer time had elapsed since a woman’s last screen at the time of the disruption. Excess risks for a given delay period were generally lower for HPV-based screeners than for cytology-based screeners. Our independent models predicted that the main drivers of CC risk were screening frequency and screening modality, and the overall impact of disruptions from the pandemic on CC outcomes may be small. However, screening disruptions disproportionately affect underscreened women, underpinning the importance of reaching such women as a critical area of focus, regardless of temporary disruptions.
Original languageEnglish
Article numbere81711
Number of pages17
Early online date12 Oct 2022
Publication statusPublished - 12 Oct 2022

Bibliographical note

Emily A Burger receives salary support from the Norwegian Cancer Society (#198073), Megan A Smith receives salary support from the National Health and Medical Research Council, Australia (APP1159491) and Cancer Institute NSW (ECF181561). James O’Mahony is funded by Ireland’s Health Research Board (EIA2017054). Matejka Rebolj receives support from Public Health England, which provided funding for evaluation of various PHE projects; member of various PHE advisory groups for cervical screening; attended meetings with various HPV assay manufacturers; fee for lecture in the last four years from Hologic, paid to employer.

Funder Grant reference number Author National Cancer Institute U01CA199334 Jane J Kim Karen Canfell Inge MCM de Kok Cancer Research UK C8162/A27047 Matejka Rebolj Alejandra Castanon Norwegian Cancer Society #198073 Emily A Burger National Health and Medical Research Council, Australia APP1159491 Megan A Smith Cancer Institute NSW ECF181561 Megan A Smith Ireland’s Health Research Board EIA2017054 James F O'Mahony Public Health England Matejka Rebolj The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. The contents are solely the responsibility of the authors and do not necessarily represent the official


  • cervical cancer
  • COVID-19
  • simulation modeling


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