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. 2023;67(4):388-394.
doi: 10.1159/000529249. Epub 2023 Jan 20.

Impact of the COVID-19 Pandemic on Cervical Cancer Screening in São Paulo State, Brazil

Toni Ricardo Martins  1   2   3 , Steven S Witkin  1   4 , Maria Cássia Mendes-Corrêa  1   2 , Amanda Scancella de Godoy  5 , Lise Cury  6 , Marcelo Luiz Balancin  6 , Alexandre Muxfeldt Ab'Saber  6 , Stela Verzinhasse Peres  6 , Sandra Messias  7 , Tânia Regina Tozetto Mendoza  1 , Adhemar Longatto-Filho  8   9   10   11
Affiliations

Impact of the COVID-19 Pandemic on Cervical Cancer Screening in São Paulo State, Brazil

Toni Ricardo Martins et al. Acta Cytol. 2023.

Abstract

Introduction: The early identification of precursor lesions followed by appropriate treatment prevents development of cervical cancer and its consequences.

Objective: The present study evaluated the influence of the COVID-19 pandemic on cervical cancer screening by comparing the quantity of tests to detect cervical cellular changes performed in São Paulo state in 2019, prior to the detection of SARS-CoV-2 in Brazil, to the first (2020) and second (2021) years following its appearance.

Materials and methods: Data from Fundação Oncocentro de São Paulo (FOSP), the agency that analyses approximately 220,000 Papanicolaou (Pap) tests annually, were reviewed.

Results: A median of 1,835 Pap tests were performed in 55 municipalities in 2019. This was reduced to 815 tests in 2020, a 56% decrease (p = 0.0026). In 2021, the median number was 1,745, a 53% increase over 2020 levels (p = 0.0233). The 26 municipalities with >1,000 tests in 2020 had a median reduction from 4,433 in 2019 to 2,580 in 2020 (p = 0. 0046). The 29 municipalities with <1,000 tests had a median reduction from 951 in 2019 to 554 in 2020 (p < 0.0001). There was a 44% reduction in the number of follow-up cytological evaluations from 2019 to 2020, followed by a 30% increase in the following year. However, the percentage of women with a normal finding or with any abnormality remained unchanged. The findings from a histological evaluation of women in São Paulo city indicated that the percent of cases positive for CIN-1 (p < 0.0410) and CIN-3 (p < 0.0012) increased in 2020 and 2021 as compared to 2019 levels.

Conclusion: A reduction in testing for cervical cancer in the first year of the COVID-19 pandemic, accompanied by an elevated incidence of precancerous lesions in each of the first 2 years following its initiation, may portend a subsequent increased occurrence of cervical cancer in Brazil.

Keywords: COVID-19 pandemic; Cervical cancer screening; Neoplasia; Papanicolaou test.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Comparison of Pap tests performed in 2019, 2020, and 2021 by municipality that performed more than 1,000 exams in 2020 in the São Paulo state. SOURCE: FOSP.
Fig. 2
Fig. 2
Comparison of Pap tests performed in 2019, 2020, and 2021 by municipality that performed less than 1,000 exams in 2020 in the São Paulo state. SOURCE: FOSP.
See this image and copyright information in PMC

References

    1. World Health Organization − Cervical Cancer [cited 2022 Apr 4]. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer.
    1. Simms KT, Steinberg J, Caruana M, Smith MA, Lew JB, Soerjomataram I, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99 a modelling study. Lancet Oncol. 2019 Mar;20((3)):394–407. - PubMed
    1. Instituto Nacional de Câncer José Alencar Gomes da Silva Coordenação de Prevenção e Vigilância. Estimativa. 2020. Rio de Janeiro. [cited 2022 Apr 4]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//....
    1. Ginsburg O, Basu P, Kapambwe S, et al. Eliminating cervical cancer in the COVID-19 era. Nat Cancer. 2021;2:133–134. - PubMed
    1. Costa RF, Longatto-Filho A, Pinheiro C, Zeferino LC, Fregnani JH. Historical analysis of the Brazilian cervical cancer screening program from 2006 to 2013 a time for reflection. PLoS One. 2015 Sep 24;10((9)):e0138945. - PMC - PubMed

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