Impact of COVID-19 pandemic on cervical cancer screening: Comparison between healthy women and disabled population; A nationwide study in South Korea

Abstract

Objectives Since the COVID-19 pandemic emerged, governments worldwide have enforced quarantines, and citizens have avoided contact with others to reduce viral transmission. This has caused access to public health care, such as cancer screening and routine visits to physicians, to decrease substantially. Cervical cancer screening is essential to the prevention of cervical cancer. However, the influence COVID-19 has on cervical cancer screening in South Korea has not been yet assessed. The aim of this study was to evaluate the impact of the COVID-19 pandemic on cervical cancer screening by comparing the number of women screened before and during the pandemic.

Methods Using Korean National Health Insurance Service Database (KNHISD), women eligible for cervical cancer screening from 2017 to 2020 (n = 21,002,874) were selected for evaluation of change in screening attendance as a result of the COVID-19 pandemic. The study population was classified into subgroups according to age, income, region, disability grade, and type to determine the factors that were affected by COVID-19. We calculated the rate of change between the average of 2017–2019, which was before the COVID-19 pandemic, and the 2020 screening number.

Results The cervical cancer screening rate in 2020 decreased by 17.2% (OR:0.828, 95% CI:0.827-0.830) compared to that of 2017-2019. When analyzed according to subgroups, age group 40-49 (OR:0.744, 95% CI:0.740-0.747), 50-59 (OR:0.774, 95% CI:0.770-0.777), and 60 or older (OR:0.795, 95% CI:0.792-0.797) showed a significant decrease in cervical cancer screening rate after the COVID-19 pandemic. Also, disabilities resulted in a reduction of the screening rate (OR=0.576, 95% CI=0.573-0.578), and those with disabilities presented a lower tendency to participate in the screening since the pandemic (OR:0.758, 95% CI:0.751-0.765). Among various disability types, people with physical, brain injury, visual, hearing, speech, mental, renal, respiratory, liver, and facial disabilities showed more than a 20% drop in cervical cancer screening rate after the emergence of the pandemic.

Conclusions This study reveals a significant disruption in the rate of screening tests for cervical cancer during the COVID-19 pandemic in South Korea. Also, patients older than 40 years and those with disabilities tend to participate less in the screening test since the pandemic. Therefore, catch-up on the missed screening test is required to reduce the incidence and severity of cervical cancer that is expected as a consequence of decreased screening activities. Also, healthcare providers should consider a way to expand care to vulnerable populations, such as ambulatory gynecologic considerations in the era of pandemics.