The effect of healthcare disruptions during the COVID-19 pandemic on colposcopy services and practice: A systematic review and meta-analysis.

INTRODUCTION

The healthcare reorganization during the COVID-19 pandemic affected colposcopy services and cervical cancer prevention, particularly in those countries where healthcare systems were already under-resourced. This review aimed to quantify the reduction in colposcopy services across countries during the COVID-19 pandemic and to determine whether the data source per study and cervical cancer screening coverage per country influenced the extent of these reductions.

MATERIAL AND

METHODS

Studies reporting comparative data on colposcopy services between the COVID-19 pre-pandemic and pandemic period were included. MEDLINE, Embase, EMCare, Covid-19 Research, British Nursing Index, APA PsycINFO, and Allied and Complimentary Medicine databases were searched for studies published from March 2020 to December 2023. The Newcastle-Ottawa scale was used for risk of bias assessment. The number of colposcopies, cervical treatments, pre-invasive lesions diagnoses, and cervical cancer diagnoses per month were compared between the pre-pandemic (before March 2020) and pandemic period (after March 2020). The effect measure was the standardized mean difference. Heterogeneity was evaluated with the chi-squared test and quantified with the I2 method. A meta-regression was performed, considering the data source (regional/national databases/registries or institutional databases) and the screening coverage according to World Health Organization data (≥70% or <70%) as moderators. The review was registered on PROSPERO (CRD42023447188).

RESULTS

Thirteen studies were included. Twelve were of good/high quality according to the Newcastle-Ottawa scale. The standardized mean difference between the pre-pandemic and pandemic periods was -1.60 (95% CI -2.49 to -0.72, p = 0.004) for colposcopies (4 studies, I2 = 60.97%, p = 0.075), -1.70 (95% CI -2.50 to -0.90, p < 0.001) for cervical treatments (5 studies, I2 = 52.92%, p = 0.081), -4.61 (95% CI -7.90 to -1.33, p = 0.006) for pre-invasive lesion diagnoses (4 studies, I2 = 92.45%, p < 0.001), and -0.85 (95% CI -1.52 to -0.19, p = 0.012) for cervical cancer diagnoses (9 studies, I2 = 71.07%, p = 0.002). At meta-regression, further reductions for cervical treatments and pre-invasive lesion diagnoses were observed in the case of screening coverage <70%.

CONCLUSIONS

During the COVID-19 pandemic, a reduction in colposcopies, cervical treatments, pre-invasive lesions diagnoses, and invasive cancer diagnoses was observed. Since a screening coverage of <70% heightened these declines, increasing such coverage could lead to better resilience of cervical cancer prevention services to future crises.