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

TY - JOUR

T1 - 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

AU - Burger, Emily A

AU - de Kok, Inge M C M

AU - O'Mahony, James F

AU - Rebolj, Matejka

AU - Jansen, Erik E L

AU - de Bondt, Daniel D

AU - Killen, James

AU - Hanley, Sharon J

AU - Castanon, Alejandra

AU - Regan, Mary Caroline

AU - Kim, Jane J

AU - Canfell, Karen

AU - Smith, Megan A

N1 - Funding Information: Karen Canfell receives salary support from the National Health and Medical Research Council, Australia (APP1194679). Karen Canfell is the co-PI of an investigator-initiated trial of cervical cancer screening, Compass, run by the VCS Foundation, which is a government-funded not-for-profit charity. Neither KC nor her institution have received funding from industry for this or any other research project. Funding Information: ‡Karen Canfell receives salary support from the National Health and Medical Research Council, Australia (APP1194679).Karen Canfell is the co-PI of an investigator- initiated trial of cervical cancer screening, Compass, run by the VCS Foundation, which is a government-funded not-for- profit charity. Neither KC nor her institution have received funding from industry for this or any other research project. Funding Information: Emily A Burger receives salary support from the Norwegian Cancer Society (#198073), Megan A Smith receives salary support from the National Health and Medical Research Council, Australia (APP1159491) and Cancer Institute NSW (ECF181561). James O’Mahony is funded by Ireland’s Health Research Board (EIA2017054). Matejka Rebolj receives support from Public Health England, which provided funding for evaluation of various PHE projects; member of various PHE advisory groups for cervical screening; attended meetings with various HPV assay manufacturers; fee for lecture in the last four years from Hologic, paid to employer. Publisher Copyright: © Burger et al.

PY - 2022/10/12

Y1 - 2022/10/12

N2 - 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.

AB - 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.

KW - COVID-19/epidemiology

KW - Cervix Uteri

KW - Early Detection of Cancer

KW - Female

KW - Humans

KW - Papillomavirus Infections

KW - Uterine Cervical Neoplasms/diagnosis

UR - http://www.scopus.com/inward/record.url?scp=85141476860&partnerID=8YFLogxK

U2 - 10.7554/eLife.81711

DO - 10.7554/eLife.81711

M3 - Article

C2 - 36222673

SN - 2050-084X

VL - 11

JO - eLife

JF - eLife

M1 - e81711

ER -