Resilience of the Dutch HPV-based cervical screening programme during the COVID-19 pandemic

E M G Olthof; C A Aitken; A G Siebers; F J van Kemenade; I M C M de Kok

doi:10.1016/j.puhe.2023.11.026

Resilience of the Dutch HPV-based cervical screening programme during the COVID-19 pandemic

Public Health. 2024 Feb:227:42-48. doi: 10.1016/j.puhe.2023.11.026. Epub 2023 Dec 16.

Authors

E M G Olthof¹, C A Aitken², A G Siebers³, F J van Kemenade⁴, I M C M de Kok⁵

Affiliations

¹ Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands. Electronic address: e.olthof@erasmusmc.nl.
² Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Erasmus MC University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands.
³ The Dutch Nationwide Pathology Databank (PALGA Foundation), Houten, the Netherlands.
⁴ Erasmus MC University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands.
⁵ Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands.

PMID: 38103276
DOI: 10.1016/j.puhe.2023.11.026

Abstract

Objectives: Organisation of a screening programme influences programme resilience to a disruption as COVID-19. Due to COVID-19, the Dutch human papillomavirus-based cervical screening programme was temporarily suspended. Afterwards, multiple measures have been taken to catch-up participation. This study aimed to investigate programme resilience by examining the effect of COVID-19 and programme measures taken on participation in cervical screening.

Study design: Observational cohort study.

Methods: Data from the national screening registry and Dutch nationwide pathology databank (Palga) were used on invitations and follow-up in 2018/2019 (pre-COVID) and 2020 (COVID). Sending invitations, reminders and self-sampling kits were suspended from March to July 2020. Main outcome measures include distribution of participant characteristics (age, region and screening history), participation rates by age and region, time between invitation and participation (i.e. response time) and self-sampling use per month.

Results: Participation rate was significantly lower in 2020 (49.8%) compared to 2018/19 (56.8%, P < 0.001), in all ages and regions. Compared to 2018/19, participation rates decreased most in women invited from January to March 2020 (-6.7%, -9.1% and -10.4%, respectively). From August, participation rates started to recover (difference between -0.8% and -2.7%). Median response time was longer in February and March (2020: 143 and 173 days; 2018/19: 53 and 55 days) and comparable from July onwards (median difference 0-6 days). Self-sampling use was higher in 2020 (16.3%) compared to 2018/19 (7.6%).

Conclusions: The pandemic impacted participation rates in the Dutch cervical screening programme, especially of women invited before the programme pause. Implementation of self-sampling in national cervical screening programmes could increase participation rates and could serve as an alternative screening method in times of exceptional health care circumstances, such as a pandemic. Due to the well-organised programme and measures taken to catch-up participation, the impact of COVID-19 on the screening programme remained small.

Keywords: COVID-19; Cervical cancer screening; HPV screening; Resilience; Self-sampling; Suspension.

Publication types

Observational Study

MeSH terms

COVID-19* / diagnosis
COVID-19* / epidemiology
Early Detection of Cancer / methods
Female
Humans
Mass Screening / methods
Pandemics
Papillomaviridae
Papillomavirus Infections* / diagnosis
Papillomavirus Infections* / epidemiology
Resilience, Psychological*
Uterine Cervical Neoplasms* / diagnosis
Uterine Cervical Neoplasms* / epidemiology
Uterine Cervical Neoplasms* / prevention & control
Vaginal Smears