COVID-19 and cancer screening in Scotland: A national and coordinated approach to minimising harm

Abstract

Screening is an important component of cancer control internationally. In Scotland, the National Health Service Scotland provides screening programmes for cervical, bowel and breast cancers. The COVID-19 pandemic resulted in the suspension of these programmes in March 2020. We describe the integrated approach to managing the impact of the pandemic on cancer screening programmes in Scotland throughout 2020. We outline the policy context and decision-making process leading to suspension, and the criteria and framework informing the subsequent, staggered, restart in subsequent months. The decision to suspend screening services in order to protect screening invitees and staff, and manage NHS capacity, was made after review of numbers of screening participants likely to be affected, and the potential number of delayed cancer diagnoses. Restart principles and a detailed route map plan were developed for each programme, seeking to ensure broad consistency of approach across the programmes and nationally. Early data indicates bowel, breast and cervical screening participation has increased since restart. Primary care has had to adapt to new infection prevention control measures for delivery of cervical screening. Cancer charities provided cancer intelligence and policy briefs to national bodies and Scottish Government, as well as supporting the public, patients and screening invitees through information and awareness campaigns. Emerging from the pandemic, there is recognition of the need and the opportunity to transform and renew both cancer and screening services in Scotland, and in particular to address long-standing workforce capacity problems through innovation and investment, and to continue to prioritise addressing health inequalities.

Keywords: COVID-19; Cancer screening; Impact of pandemic; Monitoring impact; Programmatic screening; Screening restart; Screening suspension.

Fig. 1

NHS Scotland Screening Recovery Routemap.

Fig. 2

Breast screening uptake by month, for 2019/20 and 2020/21. Participation rates are conditional on being invited.

Fig. 3

Cumulative uptake for the Scottish Bowel Screening Programme, for 2019/20 and 2020/21.

Fig. 4

Cumulative uptake for the most and least deprived postcodes in the Scottish Bowel Screening Programme, for 2019/20 and 2020/21.

Fig. 5

Actual versus anticipated cervical cancer screening samples processed from August 2020 –March 2021. Participation rates are conditional on being invited. Data reflect a complex restart process. Figures received for August are actually from 30 June – 31 August; only half the anticipated number of invitations were sent out in July and August; September 2020 data also highlights a mailer incident in August where around 13,000 non-routine invitations were not sent out and were subsequently sent out at the start of November.