COVID-19 has disrupted cervical screening in several countries, due to a range of policy-, health-service and participant-related factors. Using three well-established models of cervical cancer natural history adapted to simulate screening across four countries, we compared the impact of a range of standardised screening disruption scenarios in four countries that vary in their cervical cancer prevention programs. All scenarios assumed a 6- or 12-month disruption followed by a rapid catch-up of missed screens. Cervical screening disruptions could increase cervical cancer cases by up to 5-6%. In all settings, more than 60% of the excess cancer burden due to disruptions are likely to have occurred in women aged less than 50 years in 2020, including settings where women in their 30s have previously been offered HPV vaccination. Approximately 15-30% of cancers predicted to result from disruptions could be prevented by maintaining colposcopy and precancer treatment services during any disruption period. Disruptions to primary screening had greater adverse effects in situations where women due to attend for screening in 2020 had cytology (vs. HPV) as their previous primary test. Rapid catch-up would dramatically increase demand for HPV tests in 2021, which it may not be feasible to meet because of competing demands on the testing machines and reagents due to COVID tests. These findings can inform future prioritisation strategies for catch-up that balance potential constraints on resourcing with clinical need.
This work was supported by the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Council NSW (MH, XO), Cancer Research UK (grant number C8162/A27047 to AC and MR), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB and JK), Norwegian Cancer Society (#198073 to EAB).
These funders had no role in the study design; collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit.
We gratefully acknowledge Stephen Sy, Mary Caroline Regan, and Catherine Regan for assisting with submitting and processing model runs. This work was performed on behalf of the Screening Working Group (WG2) of the COVID-19 and Cancer Global Modelling Consortium (CCGMC.org) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2.
- cervical screening
- cancer screening
- Cervical cancer
- Cancer screening