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.

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.

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

  • 1,111
    views
  • 136
    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
    2. Genetics and Genomics
    Tianyu Zhao, Hui Li ... Li Chen
    Research Article

    Alzheimer’s disease (AD) is a complex degenerative disease of the central nervous system, and elucidating its pathogenesis remains challenging. In this study, we used the inverse-variance weighted (IVW) model as the major analysis method to perform hypothesis-free Mendelian randomization (MR) analysis on the data from MRC IEU OpenGWAS (18,097 exposure traits and 16 AD outcome traits), and conducted sensitivity analysis with six models, to assess the robustness of the IVW results, to identify various classes of risk or protective factors for AD, early-onset AD, and late-onset AD. We generated 400,274 data entries in total, among which the major analysis method of the IVW model consists of 73,129 records with 4840 exposure traits, which fall into 10 categories: Disease, Medical laboratory science, Imaging, Anthropometric, Treatment, Molecular trait, Gut microbiota, Past history, Family history, and Lifestyle trait. More importantly, a freely accessed online platform called MRAD (https://gwasmrad.com/mrad/) has been developed using the Shiny package with MR analysis results. Additionally, novel potential AD therapeutic targets (CD33, TBCA, VPS29, GNAI3, PSME1) are identified, among which CD33 was positively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. TBCA and VPS29 were negatively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. GNAI3 and PSME1 were negatively associated with the main outcome traits of AD, as well as with LOAD, but had no significant causal association with EOAD. The findings of our research advance our understanding of the etiology of AD.

    1. Epidemiology and Global Health
    Xiaoning Wang, Jinxiang Zhao ... Dong Liu
    Research Article

    Artificially sweetened beverages containing noncaloric monosaccharides were suggested as healthier alternatives to sugar-sweetened beverages. Nevertheless, the potential detrimental effects of these noncaloric monosaccharides on blood vessel function remain inadequately understood. We have established a zebrafish model that exhibits significant excessive angiogenesis induced by high glucose, resembling the hyperangiogenic characteristics observed in proliferative diabetic retinopathy (PDR). Utilizing this model, we observed that glucose and noncaloric monosaccharides could induce excessive formation of blood vessels, especially intersegmental vessels (ISVs). The excessively branched vessels were observed to be formed by ectopic activation of quiescent endothelial cells (ECs) into tip cells. Single-cell transcriptomic sequencing analysis of the ECs in the embryos exposed to high glucose revealed an augmented ratio of capillary ECs, proliferating ECs, and a series of upregulated proangiogenic genes. Further analysis and experiments validated that reduced foxo1a mediated the excessive angiogenesis induced by monosaccharides via upregulating the expression of marcksl1a. This study has provided new evidence showing the negative effects of noncaloric monosaccharides on the vascular system and the underlying mechanisms.