Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.
This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board (grant number EIA-2017–054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication.
- *Early Detection of Cancer
- *Mass Screening
- Health Services Accessibility
- Healthcare Disparities
- Uterine Cervical Neoplasms/*diagnosis