Cervical screening during the COVID-19 pandemic: optimising recovery strategies

Alejandra Castanon; Matejka Rebolj; Emily Annika Burger; Inge M.C.M. de Kok; Megan A. Smith; Sharon J.B. Hanley; Francesca Maria Carozzi; Stuart Peacock; James F. O'Mahony

doi:10.1016/S2468-2667(21)00078-5

Cervical screening during the COVID-19 pandemic: optimising recovery strategies

Alejandra Castanon^*
, Matejka Rebolj
, Emily Annika Burger
, Inge M.C.M. de Kok
, Megan A. Smith
, Sharon J.B. Hanley
, Francesca Maria Carozzi
, Stuart Peacock
, James F. O'Mahony

^*Corresponding author for this work

Public Health

King's College London
Harvard T.H. Chan School of Public Health
University of Oslo
The University of Sydney
Hokkaido University
Institute for the Study and Prevention of Cancer
Simon Fraser University
British Columbia Cancer Research Institute
Canadian Centre for Applied Research in Cancer Control
Trinity College Dublin

Research output: Contribution to journal › Review article › Academic › peer-review

44 Citations (Scopus)

Abstract

Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.

Original language	English
Pages (from-to)	e522-e527
Journal	The Lancet Public Health
Volume	6
Issue number	7
DOIs	https://doi.org/10.1016/S2468-2667(21)00078-5
Publication status	Published - 30 Apr 2021

Bibliographical note

Funding Information:
This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board (grant number EIA-2017?054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication.

Funding Information:
This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board ( grant number EIA-2017–054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication.

Funding Information:
MR reports funding from Hologic and grants from Public Health England, outside of the submitted work. MAS reports grants from the National Health and Medical Research Council and the Cancer Institute New South Wales. SJBH reports grants from National Cancer Centre Japan. SP reports being a member of the Board of Directors for the Canadian Agency for Drugs and Technologies in Health. All other authors declare no competing interests.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1016/S2468-2667(21)00078-5

Cite this

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title = "Cervical screening during the COVID-19 pandemic: optimising recovery strategies",

abstract = "Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.",

author = "Alejandra Castanon and Matejka Rebolj and Burger, \{Emily Annika\} and \{de Kok\}, \{Inge M.C.M.\} and Smith, \{Megan A.\} and Hanley, \{Sharon J.B.\} and Carozzi, \{Francesca Maria\} and Stuart Peacock and O'Mahony, \{James F.\}",

note = "Funding Information: This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board (grant number EIA-2017?054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (\#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication. Funding Information: This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board ( grant number EIA-2017{\textendash}054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (\#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication. Funding Information: MR reports funding from Hologic and grants from Public Health England, outside of the submitted work. MAS reports grants from the National Health and Medical Research Council and the Cancer Institute New South Wales. SJBH reports grants from National Cancer Centre Japan. SP reports being a member of the Board of Directors for the Canadian Agency for Drugs and Technologies in Health. All other authors declare no competing interests. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",

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T2 - optimising recovery strategies

AU - Castanon, Alejandra

AU - Rebolj, Matejka

AU - Burger, Emily Annika

AU - de Kok, Inge M.C.M.

AU - Smith, Megan A.

AU - Hanley, Sharon J.B.

AU - Carozzi, Francesca Maria

AU - Peacock, Stuart

AU - O'Mahony, James F.

N1 - Funding Information: This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board (grant number EIA-2017?054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication. Funding Information: This work was done on behalf of the Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) and we acknowledge all members of the CCGMC Steering Committee, Secretariat, and Working Group 2. This work was supported by Ireland's Health Research Board ( grant number EIA-2017–054 to JFOM), the National Health and Medical Research Council (Australia; grant APP1159491 to MAS), Cancer Research UK (grant number C8162/A27047 to MR and AC), Cancer Institute NSW (ECF181561 to MAS), National Institutes of Health (USA; U01CA199334 to EAB), Norwegian Cancer Society (#198073 to EAB), and the National Cancer Centre (Japan; 31-A-20 to SJBH). These funders had no role in directing or the writing of the manuscript, or the decision to submit for publication. Funding Information: MR reports funding from Hologic and grants from Public Health England, outside of the submitted work. MAS reports grants from the National Health and Medical Research Council and the Cancer Institute New South Wales. SJBH reports grants from National Cancer Centre Japan. SP reports being a member of the Board of Directors for the Canadian Agency for Drugs and Technologies in Health. All other authors declare no competing interests. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2021/4/30

Y1 - 2021/4/30

N2 - Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.

AB - Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.

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DO - 10.1016/S2468-2667(21)00078-5

M3 - Review article

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AN - SCOPUS:85108554277

SN - 2468-2667

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JO - The Lancet Public Health

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ER -

Cervical screening during the COVID-19 pandemic: optimising recovery strategies

Abstract

Bibliographical note

UN SDGs

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