Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management: cross-sectional survey of healthcare professionals

Abstract

Background: The COVID-19 pandemic has caused disruptions to cancer care by delaying diagnoses and treatment, presenting challenges and uncertainties for both patients and physicians. We conducted a nationwide online survey to investigate the effects of the pandemic and capture modifications, prompted by pandemic-related control measures, on cervical cancer screening-related activities from mid-March to mid-August 2020, across Canada.

Methods: The survey consisted of 61 questions related to the continuum of care in cervical cancer screening and treatment: appointment scheduling, tests, colposcopy, follow-up, treatment of pre-cancerous lesions/cancer, and telemedicine. We piloted the survey with 21 Canadian experts in cervical cancer prevention and care. We partnered with the Society of Canadian Colposcopists, Society of Gynecologic Oncology of Canada, Canadian Association of Pathologists, and Society of Obstetricians and Gynecologists of Canada, which distributed the survey to their members via email. We reached out to family physicians and nurse practitioners via MDBriefCase. The survey was also posted on McGill Channels (Department of Family Medicine News and Events) and social media platforms. The data were analyzed descriptively.

Results: Unique responses were collected from 510 participants (16 November 2020 - 28 February 2021), representing 418 fully- and 92 partially- completed surveys. Responses were from Ontario (41.0%), British Columbia (21.0%), and Alberta (12.8%), and mostly comprised family physicians/general practitioners (43.7%), and gynecologist/obstetrician professionals (21.6%). Cancelled screening appointments were mainly reported by family physicians/general practitioners (28.3%), followed by gynecologist/obstetrician professionals (19.8%), and primarily occurred in private clinics (30.5%). Decreases in the number of screening Pap tests and colposcopy procedures were consistently observed across Canadian provinces. About 90% reported that their practice/institution adopted telemedicine to communicate with patients.

Conclusions: The area most severely impacted by the pandemic was appointment scheduling, with an important level of cancellations reported. Survey results may inform resumptions of various fronts in cervical cancer screening and management.

Funding: The present work was supported by the Canadian Institutes of Health Research (operating grant COVID-19 May 2020 Rapid Research Funding Opportunity VR5-172666 Rapid Research competition and foundation grant 143347 to Eduardo L. Franco). Eliya Farah and Rami Ali each received a MSc. stipend from the Department of Oncology, McGill University.

Data availability

Code files and datasets corresponding to analyses and descriptive figures included in the manuscript and supplement are available online at Borealis, the Canadian Dataverse Repository. Source data for all figures, both embedded and supplementary, are available at the Dataverse link below with filename 'CxCaSurvey_Data.tab'.https://doi.org/10.5683/SP3/8MVU6L

The following data sets were generated
    1. El-Zein M
    (2022) CxCaSurvey_Data.tab
    Pan-Canadian Survey on the Impact of the COVID-19 Pandemic on Cervical Cancer Screening and Management.

Article and author information

Author details

  1. Mariam El-Zein

    Division of Cancer Epidemiology, McGill University, Montreal, Canada
    For correspondence
    mariam.elzein@mcgill.ca
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-5190-0370
  2. Rami Ali

    Division of Cancer Epidemiology, McGill University, Montreal, Canada
    Competing interests
    Rami Ali, received an MSc. stipend from the Gerald Bronfman Department of Oncology, McGill University..
  3. Eliya Farah

    Division of Cancer Epidemiology, McGill University, Montreal, Canada
    Competing interests
    No competing interests declared.
  4. Sarah Botting-Provost

    Division of Cancer Epidemiology, McGill University, Montreal, Canada
    Competing interests
    No competing interests declared.
  5. Eduardo L Franco

    Division of Cancer Epidemiology, McGill University, Montreal, Canada
    Competing interests
    Eduardo L Franco, Senior editor, eLife. Reports support for the present manuscript in the form of a grant to his institution is his name from the Canadian Institutes of Health Research and the Cancer Research Society; consultancy for Merck; a patent related to the discovery DNA methylation markers for early detection of cervical cancer".
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-4409-8084
  6. Survey Study Group

Funding

Canadian Institutes of Health Research (VR5-172666)

  • Eduardo L Franco

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

Reviewing Editor

  1. Electra D Paskett, The Ohio State University, United States

Ethics

Human subjects: The Faculty of Medicine Institutional Review Board (IRB) of McGill University granted ethical approval for this work on October 27, 2020 (IRB Internal Study Number: A10-B84-20A). All necessary participant consent has been obtained and the appropriate institutional forms have been archived.

Version history

  1. Preprint posted: September 25, 2022 (view preprint)
  2. Received: September 28, 2022
  3. Accepted: June 27, 2023
  4. Accepted Manuscript published: June 28, 2023 (version 1)
  5. Version of Record published: July 25, 2023 (version 2)

Copyright

© 2023, El-Zein 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.

Metrics

  • 1,050
    views
  • 131
    downloads
  • 0
    citations

Views, downloads and citations are aggregated across all versions of this paper published by eLife.

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Open citations (links to open the citations from this article in various online reference manager services)

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)

  1. Mariam El-Zein
  2. Rami Ali
  3. Eliya Farah
  4. Sarah Botting-Provost
  5. Eduardo L Franco
  6. Survey Study Group
(2023)
Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management: cross-sectional survey of healthcare professionals
eLife 12:e83764.
https://doi.org/10.7554/eLife.83764

Share this article

https://doi.org/10.7554/eLife.83764

Further reading

    1. Epidemiology and Global Health
    Xiaoxin Yu, Roger S Zoh ... David B Allison
    Review Article

    We discuss 12 misperceptions, misstatements, or mistakes concerning the use of covariates in observational or nonrandomized research. Additionally, we offer advice to help investigators, editors, reviewers, and readers make more informed decisions about conducting and interpreting research where the influence of covariates may be at issue. We primarily address misperceptions in the context of statistical management of the covariates through various forms of modeling, although we also emphasize design and model or variable selection. Other approaches to addressing the effects of covariates, including matching, have logical extensions from what we discuss here but are not dwelled upon heavily. The misperceptions, misstatements, or mistakes we discuss include accurate representation of covariates, effects of measurement error, overreliance on covariate categorization, underestimation of power loss when controlling for covariates, misinterpretation of significance in statistical models, and misconceptions about confounding variables, selecting on a collider, and p value interpretations in covariate-inclusive analyses. This condensed overview serves to correct common errors and improve research quality in general and in nutrition research specifically.

    1. Ecology
    2. Epidemiology and Global Health
    Emilia Johnson, Reuben Sunil Kumar Sharma ... Kimberly Fornace
    Research Article

    Zoonotic disease dynamics in wildlife hosts are rarely quantified at macroecological scales due to the lack of systematic surveys. Non-human primates (NHPs) host Plasmodium knowlesi, a zoonotic malaria of public health concern and the main barrier to malaria elimination in Southeast Asia. Understanding of regional P. knowlesi infection dynamics in wildlife is limited. Here, we systematically assemble reports of NHP P. knowlesi and investigate geographic determinants of prevalence in reservoir species. Meta-analysis of 6322 NHPs from 148 sites reveals that prevalence is heterogeneous across Southeast Asia, with low overall prevalence and high estimates for Malaysian Borneo. We find that regions exhibiting higher prevalence in NHPs overlap with human infection hotspots. In wildlife and humans, parasite transmission is linked to land conversion and fragmentation. By assembling remote sensing data and fitting statistical models to prevalence at multiple spatial scales, we identify novel relationships between P. knowlesi in NHPs and forest fragmentation. This suggests that higher prevalence may be contingent on habitat complexity, which would begin to explain observed geographic variation in parasite burden. These findings address critical gaps in understanding regional P. knowlesi epidemiology and indicate that prevalence in simian reservoirs may be a key spatial driver of human spillover risk.