A model-based analysis of the health impacts of COVID-19 disruptions to primary cervical screening by time since last screen for current and future disruptions

Emily A. Burger*, Inge M.C.M. de Kok, James F. O'mahony, Matejka Rebolj, Erik E.L. Jansen, Daniel D. de Bondt, James Killen, Sharon J. Hanley, Alejandra Castanon, Mary Caroline Regan, Jane J. Kim, Karen Canfell, Megan A. Smith

*Corresponding author for this work

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We evaluated how temporary disruptions to primary cervical cancer (CC) screening services may differentially impact women due to heterogeneity in their screening history and test modality. We used three CC models to project the short-and long-term health impacts assuming an underlying primary screening frequency (i.e., 1, 3, 5, or 10 yearly) under three alternative COVID-19-related screening disruption scenarios (i.e., 1-, 2-, or 5-year delay) versus no delay in the context of both cytology-based and human papillomavirus (HPV)-based screening. Models projected a relative increase in symptomatically detected cancer cases during a 1-year delay period that was 38% higher (Policy1-Cervix), 80% higher (Harvard), and 170% higher (MISCAN-Cervix) for underscreened women whose last cytology screen was 5 years prior to the disruption period compared with guidelines-compliant women (i.e., last screen 3 years prior to disruption). Over a woman’s lifetime, temporary COVID-19-related delays had less impact on lifetime risk of developing CC than screening frequency and test modality; however, CC risks increased disproportionately the longer time had elapsed since a woman’s last screen at the time of the disruption. Excess risks for a given delay period were generally lower for HPV-based screeners than for cytology-based screeners. Our independent models predicted that the main drivers of CC risk were screening frequency and screening modality, and the overall impact of disruptions from the pandemic on CC outcomes may be small. However, screening disruptions disproportionately affect underscreened women, underpinning the importance of reaching such women as a critical area of focus, regardless of temporary disruptions.

Original languageEnglish
Article numbere81711
Publication statusPublished - 12 Oct 2022

Bibliographical note

Funder Grant reference number Author
National Cancer Institute U01CA199334 Jane J Kim
Karen Canfell
Inge MCM de Kok
Cancer Research UK C8162/A27047 Matejka Rebolj
Alejandra Castanon
Norwegian Cancer Society #198073 Emily A Burger
National Health and
Medical Research Council,
APP1159491 Megan A Smith
Cancer Institute NSW ECF181561 Megan A Smith
Ireland’s Health Research
EIA2017054 James F O'Mahony
Public Health England Matejka Rebolj
The funders had no role in study design, data collection and interpretation,
or the decision to submit the work for publication. The contents are solely the
responsibility of the authors and do not necessarily represent the official views of
the National Cancer Institute or any of the above-mentioned funders.

Publisher Copyright: © Burger et al.


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