The impact of the COVID-19 pandemic on organised cervical cancer screening: The first results of the Slovenian cervical screening programme and registry

Abstract

Background: The COVID-19 pandemic threatens the impact of cervical cancer screening and global cervical cancer elimination goals. As cervical cancer screening programmes were adjusting to the new situation, we evaluated the intensity, quality, and outcomes of cervical cancer screening in Slovenia in the first seven months of the pandemic.

Methods: Historical observational study on data from a population-based cervical cancer screening registry. Number of cervical cytopathology (screening and follow-up), histopathology (diagnostic procedures, invasive procedures and number of newly diagnosed CIN2+ cases) and HPV test results from the entire Slovenian women population between January 1st and September 30th 2020 were compared to a three-year average of the years 2017-19.

Findings: A two-month screening lock-down between March 12th and May 8th 2020 resulted in an epidemic deficit of screening (-92%), follow-up (-70%), and HPV triage tests (-68%), as well as invasive diagnostic (-47%) and treatment (-15%) of cervical lesions. Time to diagnosis and treatment did not increase; times to laboratory results fluctuated but stayed within standards. Slovenia has entered the second epidemic intending to add as little as possible to the pandemic deficit of screening smears (-23%) and yearly CIN2+ cases (-10%). Women aged 30-39 were most affected, with the highest pandemic deficit of screening smears (-26%) and yearly CIN2+ cases (-19%).

Interpretation: The pandemic has deeply affected all levels of our lives. New vulnerable groups and inequalities have emerged that require recognition and action. To prevent long-term increases in the cervical cancer burden due to the COVID-19 pandemic, it is crucial that organised screening is maintained and monitored in settings where it can be safely and comprehensively provided.

Funding: None.

Fig. 1

Cumulative deficit and excess (%) of cervical tests and invasive procedures for women aged 20–64 from January 1st to September 30th 2020 by weeks compared to 3-year average in 2017–2019 (reference value 0). Screening (green) and follow-up (purple) cervical smears (cervical cytology), HPV triage tests (blue) and invasive diagnostic (brown) and treatment (red) procedures are shown. Vertical deviation from 0% represents cumulative relative (%) difference and point size represents absolute cumulative difference from January 1st 2020 compared to 3-year average. Data source: National Cervical Cancer Screening Registry ZORA. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Turnaround time to the results of laboratory investigation. Upper graph: gynaecologist turnaround time, middle graph: laboratory turnaround time, bottom graph: report turnaround time of cytology (left), HPV triage tests (middle) and invasive procedures (right) through weeks for the period from January 1st 2020 to September 30th 2020 (red) in comparison to a three-year average for 2017–2019 (blue). Data source: National Cervical Cancer Screening Registry ZORA. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Age-specific cumulative number of newly detected CIN2+ in Slovenia by weeks for the period from January 1st to September 30th 2020 (red) in comparison to three-year average during 2017–2019 (blue). Data at the beginning and the end of the first wave and the data at the beginning of the second wave of COVID-19 epidemics are shown; additionally, together with the largest deficit compared to the previous three-year average. Age groups: 20–29, 30–39, 40–49, 50–64. 65+, total 20–64). Data source: National Cervical Cancer Screening Registry ZORA. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)