Table 2.
Main characteristics of studies including data on cervical cancer screening.
| First author and year | Country | Data source (and target population) | Sample size | Outcome measure | Main findings | aNOS score (max 7) | |
|---|---|---|---|---|---|---|---|
| 1 | (Acuti Martellucci et al., 2021) | Italy | Population-level healthcare administrative data | NR | Number of obstetricians' worked hours; number of Pap smears performed; hourly rate of Pap smears | In the first semester of 2020, a 64.5% decrease of Pap smears was registered (compared with the same period of 2019, 12,415 vs. 4411 smears), with 0 tests performed from March 9 to June 30, 2020. Obstetricians' worked hours devoted to the screening almost doubled in the second semester of 2020 (+93.1% increase: 3445 vs 1784 h of 2019). In the second semester of 2020, 12,349 Pap smears were performed, against 7252 in 2019 (+70.3%). Overall, in 2020 screening participation was 14.8% lower than in 2019. | 7 |
| 2 | (de Pelsemaeker et al., 2021) | Belgium | Electronic histopathological reports of a single pathology laboratory | NA | Number of Pap smear samples received at pathology department | 43.3% reduction in the number of Pap smears in 2020: 5941 samples in Jan-Apr 2019 vs. 3370 in Jan-Apr 2020. | 6 |
| 3 | (DeGroff et al., 2021) | United States | Individual-level healthcare administrative data from the US National Breast and Cervical Cancer Early Detection Program screening services | 594,566 screening tests conducted between 2015 and 2020 (353,398 women) | Number of screening tests performed | Overall, the volume of screening tests in 2020 was well below that for the previous 5-year averages for the months March–June, with a sharp decline observed in March–April 2020. Screening test volumes for cervical cancer were lowest in April 2020, when those declined 84% from the 5-year average of 18,347 to 2880 in 2020. In June 2020, cervical cancer screening tests represented a 40% decline from the 5-year average (9413 vs. 15,681). Regarding race/ethnicity, the greatest decline in the number of breast cancer screening tests was during April among American Indian/ Alaskan Native women (98%) followed by Asian/Pacific Islander women (97%). | 7 |
| 4 | (Dema et al., 2022) | United Kingdom | Web-based survey in members of market research company (aged 18–59) | 6654 | Access to screening services | Only 2.5% of women aged 25–59 years reported using cervical screening services during the 4-month period following the start of a national lockdown in Britain (March 23, 2020), which is lower than the estimated use of the cervical cancer screening program among this age group for the same time period under normal circumstances (6%). | 7 |
| 5 | (Dennis et al., 2021) | United States | Nation-wide telephone surveys among participants in the US behavioral risk factor surveillance system | 2014–2019: 473,360; 2020: 121,640 | Pap tests reported | An 8.6% reduction in reported Pap tests in 2020 (38% of the total sample had a pap test) compared to 2019 (46.6%). | 7 |
| 6 | (Desta et al., 2021) | Ethiopia | Population-level healthcare administrative data | NR | Number of women 30 to 49 years of age screened for cervical cancer using VIA | The number of women 30 to 49 years of age who were screened for cervical cancer using visual inspection with acetic acid (VIA) during the second quarter of 2020 decreased by 54.8% compared to the same period of 2019 (695 vs. 314). But the Wilcoxon signed rank test has shown that there was no statistical difference between the two quarters (p-value = 0.15). | 6 |
| 7 | (Doubova et al., 2021) | Mexico | Population-level healthcare administrative data | NA | Number of women screened for cervical cancer with VIA | The average number of monthly screening tests decreased of −68% from 2019 to 2020 (216,808 vs 84,752). | 7 |
| 8 | (Gorin et al., 2021) | United States | Individual-level EMR of patients receiving routine cancer screening | 42,974 | Number of cervical cancer screening via ThinPrep and/or the human papillomavirus DNA high-risk profile | During the pandemic, analyses of cancer patterns screening as of April 25, 2020, revealed a precipitous drop in cervical cytology screening of 94% compared to the previous three years. Cervical cancer screening also decreased considerably during the shelter-in-place orders (4990 to 444 overall). | 6 |
| 9 | (Ivanuš et al., 2021) | Slovenia | Population-based cervical cancer screening registry (from the National Cervical Cancer Screening Registry – ZORA Registry), including women aged 20–64 years | NR | Number of screening tests (cervical cytopathology, histopathology and HPV tests) | Compared to the average of a three-year period (2017–2019), Slovenia entered the second wave of epidemics with a pandemic deficit of −19,460 (−23%) program screening smears, however with excess in follow-up smears (412, 4%) and HPV triage tests (523, 8%). Older women (aged 40 to 64) had significantly larger deficit of screening smears during the epidemic than younger (aged 20 to 39). Due to different intensities of scaling-up during the summer, the pandemic deficit of screening smears was significantly larger in age group 30 to 39 than in older groups and age group 20 to 29 was more similar to older groups than 30 to 39. Also, younger women had a smaller pandemic excess in follow-up smears and HPV triage tests. The opposite was observed for invasive diagnostics, for which the pandemic deficit was still larger in older women. The most affected were women in the 30–39 age group, who had the largest pandemic deficit of screening smears (−26%), the second-lowest scaling-up of FU tests (+31%), the lowest scaling-up of HPV tests during summer (+31%), and the highest epidemic (−25%) and pandemic (−18%) deficit in treatment. | 7 |
| 10 | (Kim et al., 2022) | United States | Individual-level EMR of women eligible for screening among the patients of the UCLA Health System | 113,125 women (pre-pandemic period); 116,540 (stay-at-home period); 119,324 (reopening period) | Odds ratio (OR) for screening completion | Stay-at-home vs. pre-pandemic: OR = 0.83 (95%CI, 0.76–0.91; p-value <0.001); phased reopening vs. pre-pandemic: OR = 0.69 (95% CI, 0.63–0.76; p-value <0.001); phased reopening vs stay-at-home: OR = 0.83 (95% CI, 0.76–0.92; p-value <0.001). | 6 |
| 11 | (Koczkodaj et al., 2021) | Poland | Population-level data from the National Health Fund | NR | Cytology coverage percentages from January to September in the years 2019 and 2020 | Cytology tests 16.34% (2019) vs 14.35% (2020). | 5 |
| 12 | (Laing and Johnston, 2021) | Canada | EMR of three urban primary care clinics | 6754 | Pap smear rates among patients eligible for cervical cancer screening. For reference the lockdown and re-opening stages have been identified. Lockdown = March 20, 2020, Stage 2 = June 12, 2020, Stage 3 = July 17, 2020, and Modified Stage 2 = October 13, 2020 | A total of 505 (95% CI, 20–993) patients would need to have Pap smear testing. Cervical cancer screening rates decreased by 0.23% per week. The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (95% CI, −0.3 − −14.7%). | 5 |
| 13 | (Li et al., 2021) | China | Web-based survey among registered physicians who practice obstetrics and gynecology in public hospitals | 7434 | Reported reduction in activities between January and August 2020 | 37.3% (95%CI, 35.4–39.2) reported a complete shutdown (or > 50% reduction); 22.0% (95%CI, 20.6–23.4) reported a reduction by 25%–50%; 40.7% (95%CI, 39.0–42.5) reported a reduction <25% or no change in clinical activities. | 6 |
| 14 | (Mantellini et al., 2020) | Italia | Quantitative survey of aggregated regional healthcare data | NA | Number of screening tests | In January–May 2020, 371,273 screening tests were conducted in Italy, being −55,3% compared to compared to the same period of 2019. | 6 |
| 15 | (Meggetto et al., 2021) | Canada | Multiple population-based administrative databases | NR | Monthly cervical screening test | From March to August 2020, monthly cervical screening cytology test volumes were substantially reduced compared with the same months 1 year prior (average was 29,147 tests, compared with 81,877 in 2019). From March to August 2020, the average number of individuals with a high-grade cytology result identified per month was 280 (compared to an average of 572 individuals between November 2019 and February 2020). | 7 |
| 16 | (Miller et al., 2021) | United States | Individual-level EMR of approximately 1.5 million women served by Kaiser Permanente Southern California | 2,947,686 women 21–65 years | Screening rate | Among women aged 21–29 years, screening rates in 2020 were 8% lower before the stay-at-home order, 78% lower during the stay-at-home order, and 29% lower after the stay-at-home order compared with rates during 2019. Among women aged 30–65 years, screening rates in 2020 were 3% lower before the stay-at-home order, 82% lower during the stay-at-home order, and 24% lower after the stay at-home-order compared with rates during 2019. | 6 |
| 17 | (Nogami et al., 2022) | Japan | Web- and telephone- questionnaire in the municipalities of the metropolitan area of Tokyo | NA | Number of cancer screening | During the first wave when “the State of Emergency” was first declared (March–June 2020), all subject municipalities showed a marked decrease in the number of screenings compared with the previous year, but then showed a recovery, and with the aggregate up to where they could have complete data, 82.9% were implemented compared with 2019. | 6 |
| 18 | (Ortiz et al., 2021) | Puerto Rico | Patient-level claims data from insurance database of women aged 21–65 years | 352,520 | Time trends of Pap tests | A substantial decrease occurred in screening utilization from January 2016 (2.81 per 100 person-months) to July 2020 (0.72 per 100 person-months). Screening rates were particularly low after the COVID-19–related lockdown (April 2020: 0.37 per 100 person-months). Screening rates among women aged 21–29 years dropped from 2.90 per 100 person-months (95%CI, 2.83–2.97) in January to March 2016 to 1.00 (95%CI, 0.95–1.02) during April to June 2020 (table). Among women aged 30–65 years, rates for the same comparison periods decreased from 3.85 (95%CI, 3.80–3.90) to 1.10 per 100 person-months (95%CI, 1.08–1.12). | 6 |
| 19 | (Walker et al., 2021) | Canada | Population-level data on screening participation from healthcare administrative database | 761,891 in 2019 and 404,945 in 2020 | Number of cervical cytology screening | Relative to 2019, a higher percentage of cytology screening participants in the pandemic period were 21–29 years (19.9 vs. 17.3%) and 30–39 years (25.9 vs. 23.2%) and a lower percentage were 50–59 years (19.6 vs. 22.0%) and 60–69 years of age (13.9 vs. 15.8%). | 7 |
Abbreviations: aNOS, adapted version of the Newcastle-Ottawa Scale checklist for assessing the quality of non-randomized studies; NR, not reported; NA, not applicable; EMR, electronic medical record; 95% CI 95% confidence interval; CIN, cervical intraepithelial neoplasia; VIA, visual inspection of cervix with acetic acid.