Participation in the nation-wide cervical cancer screening programme in Denmark during the COVID-19 pandemic: an observational study

  1. Tina Bech Olesen  Is a corresponding author
  2. Henry Jensen
  3. Henrik Møller
  4. Jens Winther Jensen
  5. Marianne Waldstrøm
  6. Berit Andersen
  1. The Danish Clinical Quality Program - National Clinical Registries, Denmark
  2. University of Southern Denmark, Denmark
  3. Randers Regional Hospital, Denmark

Abstract

Background: In contrast to most of the world, the cervical cancer screening programme continued in Denmark throughout the COVID-19 pandemic. We examined the cervical cancer screening participation during the pandemic in Denmark.

Methods: We included all women aged 23-64 years old invited to participate in cervical cancer screening from 2015-2021 as registered in the Cervical Cancer Screening Database combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of cervical cancer screening participation within 90, 180 and 365 days since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation.

Results: Altogether, 2,220,000 invited women (in 1,466,353 individuals) were included in the study. Before the pandemic, 36% of invited women participated in screening within 90 days, 54% participated within 180 days and 65% participated within 365 days. At the start of the pandemic, participation in cervical cancer screening within 90 days was lower (pre-lockdown PR=0.58; 95% CI: 0.56-0.59 and 1st lockdown PR=0.76; 95% CI: 0.75-0.77) compared with the previous years. A reduction in participation within 180 days was also seen during pre-lockdown (PR=0.89; 95% CI: 0.88-0.90) and 1st lockdown (PR=0.92; 95% CI: 0.91-0.93). Allowing for 365 days to participation, only a slight reduction (3%) in participation was seen with slightly lower participation in some groups (immigrants, low education and low income).

Conclusions: The overall participation in cervical cancer screening was reduced during the early phase of the pandemic. However, the decline almost diminished with longer follow-up time.

Funding: The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.

Data availability

Data availability statementIn order to comply with the Danish regulations on data privacy, the datasets generated and analysed during this project are not publicly available as the data are stored and maintained electronically at Statistics Denmark, where it only can be accessed by pre-approved researchers using a secure VPN remote access. Furthermore, no data at a personal level nor data not exclusively necessary for publication are allowed to be extracted from the secure data environment at Statistics Denmark. Access to the data can; however, be granted by the authors of the present study upon a reasonable scientific proposal within the boundaries of the present project and for scientific purposes only.

Article and author information

Author details

  1. Tina Bech Olesen

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N., Denmark
    For correspondence
    forthemanuscripts@gmail.com
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6295-7399
  2. Henry Jensen

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N., Denmark
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-4040-7334
  3. Henrik Møller

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N., Denmark
    Competing interests
    The authors declare that no competing interests exist.
  4. Jens Winther Jensen

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N., Denmark
    Competing interests
    The authors declare that no competing interests exist.
  5. Marianne Waldstrøm

    Department of Pathology, University of Southern Denmark, Vejle, Denmark
    Competing interests
    The authors declare that no competing interests exist.
  6. Berit Andersen

    Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
    Competing interests
    The authors declare that no competing interests exist.

Funding

The Danish Cancer Society (R321-A17417)

  • Tina Bech Olesen
  • Henrik Møller

The Danish regions

  • Tina Bech Olesen
  • Henry Jensen

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: Ethical considerationsThe study is registered at the Central Denmark Region's register of research projects (journal number 1-16-02-381-20). Patient consent is not required by Danish law for register-based studies.

Reviewing Editor

  1. Talía Malagón, McGill University, Canada

Publication history

  1. Received: June 30, 2022
  2. Accepted: January 17, 2023
  3. Accepted Manuscript published: January 20, 2023 (version 1)

Copyright

© 2023, Olesen et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Tina Bech Olesen
  2. Henry Jensen
  3. Henrik Møller
  4. Jens Winther Jensen
  5. Marianne Waldstrøm
  6. Berit Andersen
(2023)
Participation in the nation-wide cervical cancer screening programme in Denmark during the COVID-19 pandemic: an observational study
eLife 12:e81522.
https://doi.org/10.7554/eLife.81522
  1. Further reading

Further reading

    1. Epidemiology and Global Health
    Paolo Giorgi Rossi, Giuliano Carrozzi ... Paola Mantellini
    Research Article

    Background: In Italy, Regions have the mandate to implement population-based screening programs for breast, cervical, and colorectal cancer. From March to May 2020, a severe lockdown was imposed due to the COVID-19 pandemic by the Italian Ministry of Health, with the suspension of screening programs. This paper describes the impact of the pandemic on Italian screening activities and test coverage in 2020 overall and by socio-economic characteristics.

    Methods: The regional number of subjects invited and of screening tests performed in 2020 were compared with those in 2019. Invitation and examination coverage were also calculated. PASSI surveillance system, through telephone interviews, collects information about screening test uptake by test provider (public screening and private opportunistic). Test coverage and test uptake in the last year were computed, by educational attainment, perceived economic difficulties, and citizenship.

    Results: A reduction of subjects invited and tests performed, with differences between periods and geographic macro areas, was observed in 2020 vs. 2019. The reduction in examination coverage was larger than that in invitation coverage for all screening programs. From the second half of 2020, the trend for test coverage showed a decrease in all the macro areas for all the screening programs. Compared with the pre-pandemic period, there was a greater difference according to the level of education in the odds of having had a test last year vs. never having been screened or not being up to date with screening tests.

    Conclusions: The lockdown and the ongoing COVID-19 emergency caused an important delay in screening activities. This increased the pre-existing individual and geographical inequalities in access. The opportunistic screening did not mitigate the impact of the pandemic.

    Funding: This study was partially supported by Italian Ministry of Health - Ricerca Corrente Annual Program 2023.

    1. Epidemiology and Global Health
    2. Microbiology and Infectious Disease
    Fares Z Najar, Evan Linde ... Pratul K Agarwal
    Research Article Updated

    COVID19 has aptly revealed that airborne viruses such as SARS-CoV-2 with the ability to rapidly mutate combined with high rates of transmission and fatality can cause a deadly worldwide pandemic in a matter of weeks (Plato et al., 2021). Apart from vaccines and post-infection treatment options, strategies for preparedness will be vital in responding to the current and future pandemics. Therefore, there is wide interest in approaches that allow predictions of increase in infections (‘surges’) before they occur. We describe here real-time genomic surveillance particularly based on mutation analysis, of viral proteins as a methodology for a priori determination of surge in number of infection cases. The full results are available for SARS-CoV-2 at http://pandemics.okstate.edu/covid19/, and are updated daily as new virus sequences become available. This approach is generic and will also be applicable to other pathogens.