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Flemish population-based cancer screening programs: impact of COVID-19 related shutdown on short-term key performance
Svetlana Jidkova1,2, Sarah Hoeck3,4, Eliane Kellen3,5
1Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. svetlana.jidkova@ugent.be.
Background:
Many breast, colorectal, and cervical cancer screening programs were disrupted due to the COVID-19 pandemic. This study aimed to estimate the short-term impact of the temporary shutdown (from March until May- June) of the cancer screening programs invitations in Flanders (Belgium) by looking at invitation coverage, percentage of people screened after invitation and the screening interval.
Methods:
Yearly invitation coverage was calculated as the number of people who received an invitation, as a proportion of the people who should have received an invitation that year. Weekly response to the invitation was calculated as the number of people who were screened within 40 days of their date of invitation, as a percentage of the people who received an invitation that week (as a proxy for willingness to screen). Weekly screening interval was calculated as the mean number of months between the current screening and the previous screening of all the people who screened that week. The two last indicators were calculated for each week in 2019 and 2020, after which the difference between that week's value in 2020 and 2019 with 95% confidence intervals. Results of these two indicators were also analysed after stratification for gender, age and participation history.
Results:
Invitation coverage was not impacted in the colorectal and cervical cancer screening program. In the breast cancer screening program invitation coverage went down from 97.5% (2019) to 88.7% (2020), and the backlog of invitations was largely resolved in the first six months of 2021. The willingness to screen was minimally influenced by COVID-19. The breast cancer screening program had a temporary increase in screening interval in the first months following the restart after COVID-19 related shutdown, when it was on average 2.1 months longer than in 2019.
Conclusions:
Willingness to screen was minimally influenced by COVID-19, but there may be an influence on screening coverage because of lower invitation coverage, mainly for the for breast Cancer Screening Program. The increases in screening intervals for the three Cancer Screening Program seem reasonable and would probably not significantly increase the risk of delayed screening cancer diagnoses. When restarting a Cancer Screening Program after a COVID-19 related shutdown, monitoring is crucial.
Insights
COVID-19 disrupted cancer screening invitations, particularly for breast cancer, reducing coverage. However, willingness to screen remained high, and screening intervals returned to normal, suggesting minimal long-term impact on cancer diagnosis risks.
Area of Science:
- Public Health
- Epidemiology
- Cancer Screening
Background:
- COVID-19 pandemic led to significant disruptions in established breast, colorectal, and cervical cancer screening programs.
- Temporary shutdowns of screening invitations occurred between March and May-June in Flanders, Belgium.
- The study assesses the immediate effects of these disruptions on screening program performance.
Purpose of the Study:
- To estimate the short-term impact of the COVID-19 pandemic-related shutdown on cancer screening programs in Flanders.
- To analyze changes in invitation coverage, screening response rates, and screening intervals.
- To evaluate the influence of the pandemic on population-level cancer screening adherence.
Main Methods:
- Invitation coverage calculated as the proportion of intended invitations sent.
- Weekly response to invitation (willingness to screen) measured as screening within 40 days of invitation.
- Weekly screening interval calculated as the mean time between consecutive screenings.
- Comparison of 2020 data with 2019 data, stratified by gender, age, and participation history.
Main Results:
- Invitation coverage remained stable for colorectal and cervical cancer screening but decreased significantly for breast cancer screening (97.5% to 88.7%).
- Willingness to screen showed minimal influence from the pandemic.
- A temporary increase in the breast cancer screening interval (average 2.1 months longer) was observed post-shutdown.
Conclusions:
- While willingness to screen was minimally affected, reduced invitation coverage, especially for breast cancer screening, poses a potential concern.
- Observed increases in screening intervals appear manageable and unlikely to significantly elevate the risk of delayed cancer diagnoses.
- Continuous monitoring is essential when resuming cancer screening programs after pandemic-related interruptions.
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