Cervical Cancer Prevention Lagged During COVID

Authors: Tabby Khan, MD, MPH, Medical Director; Erin Sucharda, Co-Chair, Varanidae; Zane Wruble, Co-Chair, Varanidae

Preventative measures from several specialties can help curb the potential effects of missed screenings.

Fifty years ago, cervical cancer was one of the most deadly cancers, killing roughly 7,500 women in the United States each year. Today, that number has been cut nearly in half, to 4,300 annual deaths. But it could still be much lower than it is — cervical cancer is almost entirely preventable with protective vaccinations and screenings which includes Pap tests that look for pre-cancerous cells and HPV tests that assess for disease risk. These vaccinations and tests are considered clinically routine, but they are also voluntary, and as we’ve seen with the COVID-19 pandemic, the uptake of voluntary preventative measures in the United States can be an uphill battle.

In 2020, the COVID-19 pandemic disrupted both routine screening and immunization services. Our 2020 analysis showed the decline in Pap tests and HPV screening during the early pandemic, rebounding mid-year before declining again in the fall. 

Two years later, we’re taking another look at Komodo’s Healthcare Map^TM to see if pandemic-driven declines in screenings for cervical cancer (Pap tests and pelvic exams) have been made up for in recent months. We also looked into which providers are currently performing screenings to get a better understanding of who should be engaged for targeted cervical health outreach. We teamed up with Varanidae for this analysis, our employee-led affinity group focused on supporting womxn within the organization.

We found the following: 

• There has still been no period of above-normal cervical screening rate to make up for the quarantine period.
  
  While cervical screenings have returned to pre-pandemic rates, this suggests some women have skipped, rather than rescheduled, their screening. The monthly rate of patients who receive cervical screenings in the 18 months after the onset of the pandemic was 20% less than in the 14 months leading up to the pandemic.
  
  Additional research is needed to understand if screenings missed during the pandemic will lead to later-stage cervical cancer diagnoses. Previous analyses have shown the impact of pandemic-related delays in care on breast and colorectal cancer screening.
  
  

• 42.3% of Pap tests and pelvic exams are performed by providers other than OB/GYN physicians. Other top specialties performing screenings and exams included: family practice, internal medicine, general practice, and allied health providers such as physician assistants and nurse practitioners. This emphasizes the importance of multidisciplinary approaches in improving targeted efforts to reduce the rate of cervical cancer, including broader provider engagement across multiple specialties.

This analysis highlights the urgency for action, and the broad approach that action can, and should, take. Providers across specialties should be engaged to ensure preventative measures happen at all possible impact points to minimize a worsening of outcomes, to improve cervical cancer rates overall, and reduce the burden of disease.

Read Komodo Health’s analyses on how the pandemic caused delays in breast and colorectal cancer screening.

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