Recovery strategies following COVID-19 disruption to cervical cancer screening and their impact on excess diagnoses
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Abstract
Background
The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened.
Methods
Using routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25–49 and 5 years at ages 50–64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay.
Results
Both scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities—they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000).
Conclusion
To ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.
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SciScore for 10.1101/2020.11.30.20240754: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A limitation of our analysis is that we had to rely on indirectly estimated parameter for the rate of progression of CIN to cervical cancer. This is not unusual in modelling studies, but the parameters used in this study had been previously calibrated to replicate cancer rates in England.(12) We have not taken into account the effect of …
SciScore for 10.1101/2020.11.30.20240754: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A limitation of our analysis is that we had to rely on indirectly estimated parameter for the rate of progression of CIN to cervical cancer. This is not unusual in modelling studies, but the parameters used in this study had been previously calibrated to replicate cancer rates in England.(12) We have not taken into account the effect of any delays in diagnostics and treatment of women with a positive screen, nor any drop in the coverage once screening fully resumes; both would result in additional cases of cervical cancer. Finally, we focused on the additional burden of cancer due to the disruption. Any worsening of the prognosis of screen-detectable cancers due to a delayed diagnosis was beyond the scope of our analysis but would further worsen the impact of the COVID-19 disruption. Our results show that the overall population burden of cervical cancer does not depend on whether scenario 1 or scenario 2 takes place. The two scenarios, however, clearly differ in terms of how this burden is distributed among the population. Scenario 2 culminates in a substantially higher excess risk per affected woman. Because the CIN2/3 lesions left undetected would have a longer time to progress (compared to scenario 1), it is also more likely that the excess cancers under this scenario would be diagnosed at later stages. In the name of equity, therefore, our analysis calls for measures that ensure that women do not miss an entire screening round on account of the COVID-19 disruption, i.e. s...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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