Quantification of impact of COVID-19 pandemic on cancer screening programmes – a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand

International Agency for Research on Cancer, France
Hospital Universitario San Ignacio, Colombia
Investigadora CEDES/CONICET, Argentina
Instituto Provincial del Cáncer, Argentina
Foundation Lalla Salma Cancer prevention and treatment, Morocco
Bangabandhu Sheikh Mujib Medical University, Bangladesh
Ministry of Health, Sri Lanka
National Cancer Institute of Thailand, Thailand

May 16, 2023

https://doi.org/10.7554/eLife.86527

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Version of Record updated: May 22, 2023 (This version)
Version of Record published: May 16, 2023 (Go to version)
Accepted: April 24, 2023
Preprint posted: February 8, 2023 (Go to version)
Received: January 30, 2023

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Tables
Additional files

1 figure, 6 tables and 1 additional file

Figures

Figure 1

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Number of women screened for cervical cancer in Argentina (Jujuy province only) (a), Colombia (b), Sri Lanka (c), and Bangladesh (d) by months in selected years; the bars show the number of COVID-19 cases detected by months in 2020; the green bar shows the lockdown period.

Tables

Table 1

Monthly change in number of women undergoing screening, colposcopy, and/or treatment, and high-grade CIN detected in the cervical cancer screening programme in Jujuy province, Argentina during 2019 and 2020.

Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with cytology or HPV test)*
2019 – n	4128	4140	4457	5726	5969	4036	4579	5200	6205	5973	5319	2611	58,343
2020 – n	3102	2577	1312	291	840	875	214	189	295	1351	2608	2169	15,823
Change – %*	−24.9	−37.8	−70.6	−94.9	−85.9	−78.3	−95.3	−96.4	−95.2	−77.4	−51.0	−16.9	−72.9
	*Number of women undergoing colposcopy*
2019 – n	234	272	322	374	314	240	208	378	433	356	318	305	3,754
2020 – n	62	49	37	37	60	43	13	11	18	20	20	45	415
Change – %*	−73.5	−82.0	−88.5	−90.1	−80.9	−82.1	−93.8	−97.1	−95.8	−94.4	−93.7	−85.2	−88.9
	*Number of women detected with CIN 2 or worse lesions*
2019 – n	23	34	28	41	27	29	18	42	45	30	51	31	399
2020 – n	35	26	15	19	24	21	8	8	10	15	13	24	218
Change – %*	+52.2	−23.5	−46.4	−53.7	−11.1	−27.6	−55.6	−81.0	−77.8	−50.0	−74.5	−22.6	−45.4
	*Number of LLETZ or conization performed*
2019 – n	9	12	13	30	25	16	16	18	18	18	24	20	219
2020 – n	18	10	8	4	19	14	5	4	8	9	18	9	126
Change – %*	+100.0	−16.7	−38.5	−86.7	−24.0	−12.5	−68.8	−77.8	−55.6	−50.0	−25.0	−55.0	−42.5

*

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100; HPV: human papilloma virus; CIN: cervical intraepithelial neoplasia; LLETZ: large loop excision of the transformation zone.

Table 2

Monthly change in number of women undergoing cytology screening and colposcopy in the national cervical cancer screening programme in Colombia during 2019 and 2020 (A), and monthly change in number of women undergoing mammography screening and biopsies taken in the national breast cancer screening programme in Colombia during 2019 and 2020 (B).

A	Monthly change in number of women undergoing cytology screening and colposcopy in the national cervical cancer screening programme in Colombia during 2019 and 2020
Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with cytology)*
2019 – n	40,561	52,636	47,734	45,274	47,878	48,200	44,987	46,379	49,125	41,662	45,783	36,537	546,756
2020 – n	49,680	47,205	26,564	14,510	6652	14,911	16,482	15,712	22,567	24,593	27,911	26,878	293,665
Change – %*	+22.5	−10.3	−44.3	−68.0	−86.1	−69.1	−63.4	−66.1	−54.1	−41.0	−39.0	−26.4	−46.3
	*Number of women undergoing colposcopy*
2019 – n	1614	1450	1222	1237	1249	998	1120	1182	1086	1114	1030	495	13,797
2020 – n	1235	1165	897	350	485	579	623	684	631	656	697	528	8530
Change – %*	−23.4	−19.7	−26.6	−71.7	−61.2	−42.0	−44.4	−42.1	−41.9	−41.1	−32.3	+6.7	−38.2
B	Monthly change in number of women undergoing mammography screening and biopsies taken in the national breast cancer screening programme in Colombia during 2019 and 2020
Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with mammography)*
2019 – n	9406	9050	7955	8880	8908	7966	8174	8880	8647	7779	6849	4446	96,940
2020 – n	7837	9818	6855	1259	2269	3196	3483	3739	5125	6341	7189	5731	62,842
Change – %^†	−16.7	8.5	−13.8	−85.8	−74.5	−59.9	−57.4	−57.9	−40.7	−18.5	+5.0	+28.9	−35.2
	*Number of women from whom biopsies were taken*
2019 – n	184	311	255	203	287	228	213	223	226	253	257	194	2834
2020 – n	211	302	273	98	136	148	201	207	208	264	270	256	2574
Change – %^†	+14.7	−2.9	−7.1	−51.7	−52.6	−35.1	−5.6	−7.2	−8.0	+4.3	+5.0	+32.0	−9.2

*

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100.
†

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100.

Table 3

Monthly change in number of women undergoing cytology screening and high-grade CIN detected in the national cervical cancer screening programme in Sri Lanka during 2019 and 2020 (A), and monthly change in number of women undergoing CBE screening in the national cervical cancer screening programme in Sri Lanka during 2019 and 2020 (B).

A	Monthly change in number of women undergoing cytology screening and high-grade CIN detected in the national cervical cancer screening programme in Sri Lanka during 2019 and 2020
Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with cytology)*
2019 – n	15,470	21,135	19,656	7467	12,352	13,038	11,309	11,055	11,590	11,797	11,044	15,025	160,938
2020 – n	18,293	23,313	8149	222	1947	9650	14,519	12,543	12,153	7658	6748	12,812	128,007
Change – %*	+18.2	+10.3	−58.5	−97.0	−84.2	−26.0	28.4	+13.5	+4.9	−35.1	−38.9	−14.7	−20.5
	*Number of women detected with CIN 2 or worse lesions*
2019 – n	28	10	9	2	6	10	11	16	13	13	7	24	149
2020 – n	8	10	6	0	2	11	13	6	9	11	12	8	96
Change – %*	−71.4	0.0	−33.3	−100.0	−66.7	+10.0	18.2	−62.5	−30.8	−15.4	+71.4	−66.7	−35.6
B	Monthly change in number of women undergoing CBE screening in the national cervical cancer screening programme in Sri Lanka during 2019 and 2020
Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with CBE)*
2019 – n	19,972	27,150	26,329	10,288	16,643	17,778	17,947	15,890	16,884	17,667	16,207	20,253	223,008
2020 – n	22,637	28,509	13,254	356	2303	12,271	17,982	15,563	15,966	10,057	8558	16,431	163,887
Change – %^†	+13.3	+5.0	−49.7	−96.5	−86.2	−31.0	+0.2	−2.1	−5.4	−43.1	−47.2	−18.9	−26.5

*

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100; CIN: cervical intraepithelial neoplasia.
†

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100; CBE: clinical breast examination.

Table 4

Monthly change in number of women undergoing screening with FIT in the national colorectal cancer screening programme in Thailand during 2019 and 2020.

Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with FIT)*
2019 – n	33,860	47,449	65,192	80,255	144,943	185,289	120,682	88,974	15,365	10,108	17,909	22,368	832,394
2020 – n	27,076	33,731	62,283	23,556	38,778	88,622	93,219	70,560	61,219	24,049	22,549	31,608	577,250
Change – %*	−20.0	−28.9	−4.5	−70.6	−73.2	−52.2	−22.8	−20.7	+298.4	+137.9	+25.9	+41.3	−30.7

*

Change is calculated as (numbers in 2020 -− numbers in 2019) / (numbers in 2019) ×x 100; FIT: faecal immunochemical test.

Table 5

Change in number of women undergoing VIA screening and colposcopy, and high-grade CIN detected in the national cervical cancer screening programme in Bangladesh during 2019 and 2020 (A), and change in number of women undergoing CBE and CBE positivity in the national breast cancer screening programme in Bangladesh during 2019 and 2020 (B).

A	Change in number of women undergoing VIA screening and colposcopy, and high-grade CIN detected in the national cervical cancer screening programme in Bangladesh during 2019 and 2020
Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with VIA)*
2019 – n	34,132	31,448	39,775	33,559	21,434	26,694	33,366	27,597	35,636	37,019	36,208	34,663	391,531
2020 – n	52,873	57,759	24,600	1719	2097	5078	11,740	30,644	30,250	33,466	47,093	39,088	336,407
Change – %*	+54.9	+83.7	−38.2	−94.9	−90.2	−81.0	−64.8	+11.0	−15.1%	−9.6	+30.1	+12.8	−14.1
	Number of women undergoing Colposcopy (data given for each quarter)**
2019 – n	429			342			494			1265
2020 – n	440			86			393			919
Change – %*	+2.6			−74.8			−20.4			−27.4
	Number of women detected with CIN 2 or worse lesions (data given for each quarter)**
2019 – n	106			62			75			243
2020 – n	56			38			68			162
Change – %*	−47.2			−38.7			−9.3			−33.3
B	Change in number of women undergoing CBE and CBE positivity in the national breast cancer screening programme in Bangladesh during 2019 and 2020
Year of	Month of screening												Total
screening	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
	*Number of women screened (with CBE)*
2019 – n	33,358	30,164	37,190	33,657	22,077	26,389	33,354	27,678	36,059	37,227	35,866	34,789	387,808
2020 – n	51,313	57,271	24,508	1716	2046	5022	11,712	30,540	29,991	33,336	46,609	38,717	332,781
Change – %^†	+53.8	+89.9	−34.1	−94.9	−90.7	−81.0	−64.9	+10.3	−16.8	−10.5	+30.0	+11.3	−14.2
	*Number and percentage of women who tested positive on CBE*
2019 – n	997	506	465	666	1048	1333	1202	875	856	1012	879	770	10,609
(%)	(3.0)	(1.7)	(1.3)	(2.0)	(4.7)	(5.1)	(3.6)	(3.2)	(2.4)	(2.7)	(2.5)	(2.2)	(2.7)
2020 – n	594	778	234	37	63	99	114	158	382	272	950	367	4048
(%)	(1.2)	(1.4)	(1.0)	(2.2)	(3.1)	(2.0)	(1.0)	(0.5)	(1.3)	(0.8)	(2.0)	(0.9)	(1.2)

*

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100; **Data presented are from the colposcopy clinic of the main hospital in Dhaka, Bangladesh; VIA: visual inspection with acetic acid; CIN: cervical intraepithelial neoplasia.
†

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100; CBE: clinical breast examination.

Table 6

Site-specific change in number of women undergoing VIA screening and/or colposcopy, and high-grade CIN detected in the national cervical cancer screening programme in Morocco during 2019 and 2020 (A), and site-specific change in number of women undergoing CBE screening and/or mammography investigations, and breast cancers detected in the national breast cancer screening programme in Morocco during 2019 and 2020 (B).

A	Site-specific change in number of women undergoing VIA screening and/or colposcopy, and high-grade CIN detected in the national cervical cancer screening programme in Morocco during 2019 and 2020
Year of screening	Screening site											Total
Year of screening	Tanger Tetouan Al Hoceima	Fès Meknès	Rabat Salé Kénitra	Béni Mellal Khénifra	Grand Casablanca Settat	Marrakech Safi	Drâa Tafilalet	Souss Massa	Guelmim Oued Noun	Laayoune Sakia El Hamra	Eddakhla Oued Eddahab
	*Number of women screened (with VIA)*
2019 – n	10,965	115,348	45,904	15,777	72,186	46,113	8457	22,723	2521	1180	30	341,204
2020 – n	4988	44,301	14,596	17,838	29,952	20,324	4387	13,350	2437	824	0	152,997
Change – %*	−54.5	−61.6	−68.2	13.1	−58.5	−55.9	−48.1	−41.2	−3.3	−30.2	−100.0	–55.2
	*Number of women undergoing colposcopy*
2019 – n	899	2954	1520	832	1479	340	244	726				8994
2020 – n	303	1375	865	913	409	105	80	251				4301
Change – %*	−66.3	−53.5	−43.1	9.7	−72.3	−69.1	−67.2	−65.4				–52.2
	*Number of women detected with CIN 2 or worse lesions*
2019 – n	39	43	26	20	35	2	4	15				184
2020 – n	19	34	18	43	14	0	4	14				146
Change – %*	−51.3	−20.9	−30.8	115.0	−60.0	−100.0	0.0	−6.7				–20.7
B	Site-specific change in number of women undergoing CBE screening and/or mammography investigations, and breast cancers detected in the national breast cancer screening programme in Morocco during 2019 and 2020
Year of screening	Screening site												Total
Year of screening	Tanger Tetouan Al Hoceima	Oriental	Fès Meknès	Rabat Salé Kénitra	Béni Mellal Khénifra	Grand Casablanca Settat	Marrakech Safi	Drâa Tafilalet	Souss Massa	Guelmim Oued Noun	Laayoune Sakia El Hamra	Eddakhla Oued Eddahab
	*Number of women screened (with CBE)*
2019 – n	113,755	99,230	269,517	210,892	158,305	249,501	190,757	45,150	150,947	18,569	8826	155	1,515,604
2020 – n	60,170	76,848	99,917	81,357	101,285	117,061	99,441	23,521	85,295	13,648	8047	112	766,702
Change – %^†	−47.1	−22.6	−62.9	−61.4	−36.0	−53.1	−47.9	−47.9	−43.5	−26.5	−8.8	−27.7	−49.4
	*Number and percentage of women who tested positive on CBE*
2019 – n	3908	805	4956	2888	2102	2572	1543	632	2324				21,730
(%)	(3.4)	(0.8)	(1.8)	(1.4)	(1.3)	(1.0)	(0.8)	(1.4)	(1.5)				(1.4)
2020 – n	2807	418	3265	1563	1674	1354	976	316	1244				13,617
(%)	(4.7)	(0.5)	(3.3)	(1.9)	(1.7)	(1.2)	(1.0)	(1.3)	(1.5)				(1.8)
	*Number undergoing mammography investigations among CBE-positive women*
2019 – n	1772	403	3506	2037	1378	2489	845	470	1311				14,211
2020 – n	1381	269	2267	982	709	1334	652	294	936				8824
Change – %^†	–22.1	–33.3	–35.3	–51.8	–48.5	–46.4	–22.8	–37.4	–28.6				–37.9
	*Number of women detected with breast cancers*
2019 – n	249	82	346	186	65	204	79	49	115				1375
2020 – n	213	16	271	174	65	125	91	30	127				1112
Change – %^†	–14.5	–80.5	–21.7	–6.5	0.0	–38.7	15.2	–38.8	10.4				–19.1

*

Change is calculated as (numbers in 2020 -–− numbers in 2019) / (numbers in 2019) x× 100; VIA: visual inspection with acetic acid; CIN: cervical intraepithelial neoplasia.
†

Change is calculated as (numbers in 2020 − numbers in 2019)/(numbers in 2019) × 100; CBE: clinical breast examination.

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Eric Lucas
Raul Murillo
Silvina Arrossi
Martin Bárcena
Youssef Chami
Ashrafun Nessa
Suraj Perera
Padmaka Silva
Suleeporn Sangrajrang
Richard Muwonge
Partha Basu

(2023)

Quantification of impact of COVID-19 pandemic on cancer screening programmes – a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand

eLife 12:e86527.

https://doi.org/10.7554/eLife.86527