A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia

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    This study presents important results on the predicted impact of cancer screening disruptions in Australia during the COVID-19 pandemic based on consultation with public health stakeholders. The evidence presented is solid, as simulations were based on several previously validated breast, cervical, and bowel cancer screening decision models, though the scenarios were based on hypothetical disruptions that do not always match experienced disruptions. The work will be of interest to local policy-makers, public health specialists, and cancer epidemiologists.

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Abstract

Australia introduced COVID-19 infection prevention and control measures in early 2020. To help prepare health services, the Australian Government Department of Health commissioned a modelled evaluation of the impact of disruptions to population breast, bowel, and cervical cancer screening programmes on cancer outcomes and cancer services. We used the Policy1 modelling platforms to predict outcomes for potential disruptions to cancer screening participation, covering periods of 3, 6, 9, and 12 mo. We estimated missed screens, clinical outcomes (cancer incidence, tumour staging), and various diagnostic service impacts. We found that a 12-mo screening disruption would reduce breast cancer diagnoses (9.3% population-level reduction over 2020–2021) and colorectal cancer (up to 12.1% reduction over 2020–21), and increase cervical cancer diagnoses (up to 3.6% over 2020–2022), with upstaging expected for these cancer types (2, 1.4, and 6.8% for breast, cervical, and colorectal cancers, respectively). Findings for 6–12-mo disruption scenarios illustrate that maintaining screening participation is critical to preventing an increase in the burden of cancer at a population level. We provide programme-specific insights into which outcomes are expected to change, when changes are likely to become apparent, and likely downstream impacts. This evaluation provided evidence to guide decision-making for screening programmes and emphasises the ongoing benefits of maintaining screening in the face of potential future disruptions.

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  1. Author Response

    Reviewer 2 (Public review):

    A quasi-experimental before and after design as the methodological intention should be stated in the article. Although there are equally powerful alternatives with arguably less-stringent requirements that are appropriate and well-tested for natural experiments such as that intervened by the COVID-19 pandemic given the simulation methods, as of now obtaining the actual stage distribution of cancer and the cancer-specific mortality rates before and after the pandemic is possible for making scientifically valid conclusions based on observed data to support the simulation study.

    We agree with the reviewer that a modelled before-and-after analysis would have been informative. However, the required mortality and cancer stage distribution data to inform this analysis is not yet available for …

  2. eLife assessment

    This study presents important results on the predicted impact of cancer screening disruptions in Australia during the COVID-19 pandemic based on consultation with public health stakeholders. The evidence presented is solid, as simulations were based on several previously validated breast, cervical, and bowel cancer screening decision models, though the scenarios were based on hypothetical disruptions that do not always match experienced disruptions. The work will be of interest to local policy-makers, public health specialists, and cancer epidemiologists.

  3. Reviewer #1 (Public Review):

    The authors of the current study investigated the effect of the suspension of the Australian breast, bowel and cervical cancer screening program for 3, 6, 9, or 12 months on cancer outcomes and cancer services.

    The major strengths of the current study are the usage of the validated Policy1 modelling platform to estimate the effects of delays in the screening program on cancer outcomes. Furthermore, they described a wide range of different scenarios and looked at all three national screening programs together. A clear and detailed description of the screening programs was given. The results are well-described and detailed.

    The authors reached their aim. They showed how a disruption of the breast cancer screening program of 12 months led to less screen-detected and interval invasive cancers, and to an increase …

  4. Reviewer #2 (Public Review):

    The report was based on three nation-wide cancer screening programs (breast, bowel, and cervix cancer). This paper attempts to simulate the potential impact of screening disruption on the cancer detection. The authors raised an important concern; that the screening disruption by COVID-19 pandemic would led to an increase in cervical cancer but a reduction in detection of breast and bowel cancer.

    There are some issues that must be addressed to ensure the analysis and conclusions can be clearly studied. Importantly, it is not entirely clear if the simulation methodology applied to arrive at a scientific conclusion. The authors could provide more insights on how they will address not only the change of cancer detection but also the driving some improved methods for screening helping return to pre-pandemic levels.

  5. Reviewer #3 (Public Review):

    This is an interesting manuscript with an important subject pertaining to the impact of COVID-19 pandemic on various delayed schedules of population-based cancer screening, leading to the reduction of screen-detected cancers and the possible upstaging cancers. The results were assessed by simulation model (Policy I modelling) with the demonstration of Australia scenarios including three major cancers, including breast cancer, colorectal cancer, and cervical cancer.

    Assess the impacts of COVID-19 disruption to population cancer screening for three major cancers on short-term and long-term outcomes for policy analysis.

    The merit of this study is to provide a series of simulated results under disruption scenarios but the weakness are several-fold including lacking of mortality estimates, inadequate assessments …