Study Reveals Increased Disparities in Cervical Cancer Screening Linked With COVID-19 Pandemic

Peter Ketch, MD

Women of all races and ethnicities who were referred to a colposcopy clinic for cervical cancer screening following an abnormal Pap smear during the COVID-19 pandemic had a higher likelihood of not adhering to their appointment compared with appointment data collected prior to the pandemic, according to results from a retrospective analysis presented during the 2022 SGO Annual Meeting on Women’s Cancer.¹

Results showed a 39.5% decrease in patients who presented for their colposcopy during the study period. Specifically, 71.2% of patients who comprised the COVID-19 group (n = 75) presented at least 3 months after their initial colposcopy appointment (delayed) or did not present at all (not adherent) for their appointment vs 57.4% of those who comprised the pre–COVID-19 group (n = 238; P = .0001).

Although within the COVID-19 group, all races and ethnicities experienced a higher percentage of nonadherence vs what was observed in the pre–COVID-19 group, the greatest difference in care was observed with Black women; 81.8% of these patients were classified as either delayed or not adherent vs 61.5% of White patients and 50% of Hispanic patients (P < .001).

“The COVID-19 pandemic had a substantial effect on women’s access to care with regards to all races and ethnicities in this study, where nearly two-thirds of women were delayed or not adherent to care,” lead study author Peter Ketch, MD, of the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham, and colleagues, wrote in the poster. “The greatest difference was seen with Black women who were adherent less than 20% of the time.”

The retrospective analysis evaluated women who were scheduled for a single referral-based colposcopy clinic visit between February 2020 and January 2021 compared with patients who were scheduled for the same kind of visit the year prior to the pandemic; these groups represented the COVID-19 and pre–COVID-19 groups, respectively.

Patients evaluated in the analysis had to be older than 21 years of age and they must have had an appropriate referral for their colposcopy. Evaluable patients from each group were classified into 3 categories regarding their colposcopy appointments: adherent, defined as those who came to their scheduled appointment; delayed, defined as those who attended their scheduled appointment more than 3 months after the original referral; and non-adherent, defined as those who did not go to their scheduled appointment at all. Investigators conducted the analysis by using SPSS v.26.

Those in the pre–COVID-19 group had an average age of 35 years (± 8.3 years); 66.7% of these patients were Black, 19.0% were White, 13.5% were Hispanic, and 0.8% were of another unspecified race or ethnicity. Additionally, regarding Pap smear results in this group, 10.9% were negative for intraepithelial lesion (NILM), 34.3% had atypical cells of unknown significance (ASCUS), 38.3% had low-grade squamous intraepithelial lesion (LSIL), 10.4% had atypical squamous cells, cannot rule out high-grade (ASC-H), 2.6% had atypical glandular cells (AGC), and 3.0% had high-grade squamous intraepithelial lesion (HSIL). Furthermore, 84.5% of those in the pre–COVID-19 group were positive for human papillomavirus (HPV). Most patients (69.6%) were referred for colposcopy from a health department.

The COVID-19 group had an average age of 33 years (± 8.5 years); 60.3% of patients were Black, 17.8% were White, 19.2% were Hispanic, and 2.7% were of another unspecified race or ethnicity. Regarding Pap smear results in this group, 14.9% were NILM, 24.3% had ASCUS, 35.1% had LSIL, 9.5% had ASC-H, 2.7% had AGC, and 13.5% had HSIL. Notably, 85.2% of those in this group were positive for HPV, and again, most patients (57.3%) were referred for colposcopy from a health department.

In the pre–COVID-19 group, 38.0% of Black patients, 51.1% of White patients, and 56.3% of Hispanic patients were adherent to care; 45.6%, 35.6%, and 15.6% of patients, respectively, were not adherent. Moreover, 16.5% of Black patients in this group, 13.3% of White patients, and 28.1% of Hispanic patients were delayed in receiving care.

In the COVID-19 group, 18.2% of Black patients, 38.5% of White patients, 50.0% of Hispanic patients, and 50% of patients reported as other were adherent to care; in contrast, 47.7% of Black patients, 61.5% of White patients, and 42.9% of Hispanic patients were not adherent. Moreover, 34.1% of Black patients, 0% of White patients, 7.1% of Hispanic patients, and 50% of patients reported as other received delayed care.

“Moving forward, it will be important to provide culturally relevant assessments of barriers to care and targeted interventions to narrow the gap and reach women who are lost to care,” the study authors concluded.

Reference

1. Ketch P, Boitano TKL, Evans E, et al. Increased disparities in cervical cancer screening associated with the COVID-19 pandemic. Presented at: 2022 SGO Annual Meeting on Women’s Cancer; March 18-21, 2022; San Francisco, CA. Accessed March 30, 2022. Poster #436.