Cervical cancer screening rates decreased by approximately 80% during the stay-at-home order in California during the COVID-19 pandemic (March 19-June 11, 2020). The screening rates remained 24% to 29% lower than normal after the order was lifted, according to a study by Maureen J. Miller, MD, and colleagues at the Centers for Disease Control and Prevention.1

Ensuring that women, particularly those at high risk, receive timely screening and follow-up care is essential to preventing an increased incidence of advanced cervical cancer from delayed detection, the study authors noted.

The study, which was conducted in collaboration with Kaiser Permanente Southern California (KPSC), is based on an analysis of electronic medical records from approximately 1.5 million women. During the stay-at-home order executive order in California, KPSC outpatient clinics did not close and screening visits could be scheduled.


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Among women aged 21 to 29 years, screening rates were 78% lower during the stay-at-home order and 29% lower after the order was lifted compared with rates in 2019 (Figure). Among women aged 30 to 65 years, screening rates were 82% lower during the stay-at-home order and 24% lower after the order was lifted compared with rates in 2019. A similar trend was found in all racial and ethnic groups.

Figure. Routine cervical cancer screening rates*,† among women aged 21 to 65 years in a large integrated healthcare system, by age group — Kaiser Permanente Southern California, January 1–September 30, 2019, and January 1–September 30, 2020.
*Cervical cancer screening test used is Pap test for women aged 21 to 29 years, and Pap test and human papillomavirus (HPV) testing for women aged 30 to 65 years through July 15, 2020, and HPV test alone after July 15, 2020.
Tests per 100 person-months. For women aged 21–29 years, rates were calculated as (Pap tests per person-month) x 100. For women aged 30-65 years, rates were calculated as (HPV tests per person-month) x 100.

The 2020 guidelines from the American Cancer Society recommend initiating cervical cancer screening at age 25 years and using primary human papillomavirus (HPV) testing every 5 years as the preferred method of testing through age 65 years. Pap test alone every 3 years is recommended if HPV testing is not available.2

Study limitations include the potential misclassification of surveillance tests in women with a history of cervical precancer or cancer as screening tests. Also, the KPSC findings may not be generalizable to other healthcare settings.

Furthermore, it is unclear whether the women who returned for cervical cancer screening after the reopening had missed their visits during the stay-at-home order or were due for screening after the reopening. 

This study did not include the impact of the limited and regional stay-at-home orders in California that occurred more recently (November 21, 2020-January 25, 2021) in California on cervical screening rates. 

Targeting Women at High Risk for Cervical Cancer

“The COVID-19 pandemic has highlighted a critical need for effective cancer screening methods for patients who cannot or prefer not to have in-person appointments,” Dr Miller and colleagues noted.

The study authors called for use of evidence-based approaches to education, health promotion, and information dissemination on the importance of screening for cervical cancers and precancers. Triaging women who call for cervical cancer screening appointments based on risk level and screening history may be helpful, they added.

“As the pandemic continues, public health interventions to address decreases in cancer screening rates will be critical to avoid increased incidence of advanced cancers because of delayed detection,” Miller et al concluded.

References

1. Miller MJ, Xu L, Qin J, et al. Impact of COVID-19 on cervical cancer screening rates among women aged 21-65 years in a large integrated health care system – Southern California, January 1-September 30, 2019, and January 1-September 30, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(4):109-113. doi:10.15585/mmwr.mm7004a1

2. Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346. doi:10.3322/caac.21628