Impact of disruptions and recovery for established cervical screening programs across a range of high-income country program designs, using COVID-19 as an example: A modelled analysis.
Impact of disruptions and recovery for established cervical screening programs across a range of high-income country program designs, using COVID-19 as an example: A modelled analysis.
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DOI：
10.1016/j.ypmed.2021.106623
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发表时间：
2021-10
影响因子：
5.1
通讯作者：
Canfell, Karen
中科院分区：
文献类型：
--
作者：
Smith, Megan A.;Burger, Emily A.;Castanon, Alejandra;de Kok, Inge M. C. M.;Hanley, Sharon J. B.;Rebolj, Matejka;Hall, Michaela T.;Jansen, Erik E. L.;Killen, James;O'Farrell, Xavier;Kim, Jane J.;Canfell, Karen
由于一系列政策、卫生服务和参与者相关因素，COVID-19扰乱了几个国家的宫颈筛查。使用三个完善的宫颈癌自然史模型，模拟四个国家的筛查，我们比较了四个国家宫颈癌预防计划不同的一系列标准化筛查中断情景的影响。所有场景都假设6个月或12个月的中断，然后快速赶上错过的屏幕。宫颈筛查中断可能会使宫颈癌病例增加5- 6%。在所有情况下，到2020年，超过60%的因中断而导致的额外癌症负担可能发生在50岁以下的女性中，包括30多岁的女性之前曾接受过HPV疫苗接种的情况。大约15-30%的癌症预测将导致中断可以通过在任何中断期间保持阴道镜检查和癌前治疗服务来预防。在2020年参加筛查的妇女将细胞学（相对于HPV）作为其先前的主要检测的情况下，对初级筛查的干扰会产生更大的不良影响。快速追赶将大幅增加2021年对HPV检测的需求，但由于COVID检测对检测机器和试剂的竞争性需求，可能无法满足这一需求。这些发现可以为未来的追赶优先级策略提供信息，以平衡资源的潜在限制与临床需求。
COVID-19 has disrupted cervical screening in several countries, due to a range of policy-, health-service and participant-related factors. Using three well-established models of cervical cancer natural history adapted to simulate screening across four countries, we compared the impact of a range of standardised screening disruption scenarios in four countries that vary in their cervical cancer prevention programs. All scenarios assumed a 6- or 12-month disruption followed by a rapid catch-up of missed screens. Cervical screening disruptions could increase cervical cancer cases by up to 5–6%. In all settings, more than 60% of the excess cancer burden due to disruptions are likely to have occurred in women aged less than 50 years in 2020, including settings where women in their 30s have previously been offered HPV vaccination. Approximately 15–30% of cancers predicted to result from disruptions could be prevented by maintaining colposcopy and precancer treatment services during any disruption period. Disruptions to primary screening had greater adverse effects in situations where women due to attend for screening in 2020 had cytology (vs. HPV) as their previous primary test. Rapid catch-up would dramatically increase demand for HPV tests in 2021, which it may not be feasible to meet because of competing demands on the testing machines and reagents due to COVID tests. These findings can inform future prioritisation strategies for catch-up that balance potential constraints on resourcing with clinical need.
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影响因子：
2.6
作者：
Ahrenfeldt LJ;Otavova M;Christensen K;Lindahl-Jacobsen R
通讯作者：
Lindahl-Jacobsen R
影响因子：
10.3
作者：
Gage, Julia C.;Schiffman, Mark;Kinney, Walter K.
通讯作者：
Kinney, Walter K.
影响因子：
8.9
作者：
Alkhouli, Mohamad;Nanjundappa, Aravinda;Bhatt, Deepak L.
通讯作者：
Bhatt, Deepak L.
影响因子：
6.4
作者：
Burger, Emily A.;Sy, Stephen;Kim, Jane J.
通讯作者：
Kim, Jane J.
影响因子：
254.7
作者：
Fontham, Elizabeth T. H.;Wolf, Andrew M. D.;Smith, Robert A.
通讯作者：
Smith, Robert A.