The future of cancer screening after COVID‐19 may be at home

Gorin, Sherri N. Sheinfeld; Jimbo, Masahito; Heizelman, Robert; Harmes, Kathryn M.; Harper, Diane M.

doi:10.1002/cncr.33274

Cited by 53 publications

(72 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Sweden, during the 1st wave of the COVID epidemic, cervical screening was largely cancelled, including the cancellation of 192 000 cervical screening appointments in Stockholm (42). Concordantly, a number of reports worldwide indicate a precipitous decline in cervical screening (43)(44)(45)(46)(47). The actual and potential consequences of the COVID-19 pandemic vis-à-vis increased cervical cancer incidence, treatment delay and mortality have been underscored (45,48,49).…”

Section: Discussionmentioning

confidence: 98%

“…The actual and potential consequences of the COVID-19 pandemic vis-à-vis increased cervical cancer incidence, treatment delay and mortality have been underscored (45,48,49). Home self-sampling for HPV is widely endorsed as the key strategy to avoid these pandemic-related, adverse consequences (42,44,47,(50)(51)(52)(53). As succinctly stated in a previous study (50): 'The new imperatives of the COVID-19 pandemic support self-sampled HPV testing as the primary cervical screening method'.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

et al. 2021

View full text Add to dashboard Cite

The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4-6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3-9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0-14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0-16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4-11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Emerging studies estimate that up to 67% of expected cervical cancer screenings were missed in 2020 in the United States due to COVID-19 ( Epic Health Research Network, 2020a , Epic Health Research Network, 2020b ). To prevent delays and missed screenings, future efforts may well focus on providing screening services that obviate the need for a clinic visit such as self-sampling for HPV testing ( Ajenifuja et al, 2020 ; Feldman and Haas, 2020 ; Gorin et al, 2021 ; Steben et al, 2020 ). While we have been successful in delaying patient visits during the pandemic, the potential adverse effects of this delay on cervical cancer incidence and mortality and the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 remain to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Prioritizing cervical cancer screening services during the COVID-19 pandemic: Response of an academic medical center and a public safety net hospital in California

Sawaya

Holt²,

Lamar

et al. 2021

Preventive Medicine

View full text Add to dashboard Cite

The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.

show abstract

“…The impact of the pandemic can be overcome by promoting at‐home screening tests, which also promotes access to primary health care during the post‐pandemic times as well. The emerging findings regarding home‐based patient screening indicates that it is both accessible and acceptable to the patients across diverse population groups, 17 thus reducing the embarrassment these tests accompany in a physician's office. To facilitate the concept of self‐screening for breast, cervical, and colorectal cancers, the transformation of health care institutions initiated by this pandemic needs to be sustained.…”

Section: Discussionmentioning

confidence: 99%

“…Gorin et al 17 report a precipitous drop in US national cancer screening patterns as of April 25, 2020 due to the pandemic, which was measured at 94% each for cervical cytology and breast cancer screening and 86% for colorectal cancer screening. The challenges for cancer detection as a result of delayed cancer screening include late stage of disease at the time of diagnosis, increased cancer incidence (particularly for cervical and colorectal cancer), and greater morbidity and mortality.…”

Section: Bodymentioning

confidence: 99%

A narrative review of the pathophysiology of COVID‐19 infection among cancer patients: Current evidence and research perspectives

Ramani

Naik

2021

Health Science Reports

View full text Add to dashboard Cite

Introduction The mechanism by which a suppressed immune system of a cancer patient makes them susceptible to COVID‐19 is still unclear. Any delay or discontinuation of cancer care due to the pandemic is expected to have a detrimental impact on the outcome of cancer. A few studies have addressed the incidence of COVID‐19 among cancer patients, but the small sample size of such studies makes it difficult to draw inference to the general population. Methods For our review, ‘Pubmed’ database and Google search engines were used for searching the relevant articles. The criterion used for review includes their relevance to the defined review question, which is the pathophysiological mechanism of COVID‐19 among cancer patients and the relevant therapeutic interventions therewith. This review includes 20 studies and other relevant literature which address the determinants of COVID‐19 among Cancer patients. Results Delay in cancer diagnosis will increase the stage progression of cancer patients and increased mortality in the future. A short delay in administering cancer related treatment to aid the odds of patient surviving the acute SARS‐CoV‐2 infection, should be at the discretion of the treating Physician. Oncologists dilemma in the current situation includes titrating the density of drug doses and intensity of treatment regimen, for the optimal management of metastatic and adjuvant cancer patients. Patients are thus subjected to suboptimal treatment and undetected disease recurrence, To circumvent the immunosuppressive effects of chemotherapy, Providers need to consider staggered regimen or alternate therapies such as biological/immunotherapy, targeted therapy, anti‐angiogenic drugs, hormone therapy and/or antibody‐based therapeutics. Conclusion This review provides insights on the pathogenesis of SARS‐CoV‐2, which could enable Physicians in formulating therapeutic strategies for the management of severe patients, more so in Oncology settings, thus reducing the mortality. The key is to balance the continuation of urgent cancer care, but rationing the elective treatment according to the circumstances.

show abstract

The future of cancer screening after COVID‐19 may be at home

Cited by 53 publications

References 28 publications

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

Prioritizing cervical cancer screening services during the COVID-19 pandemic: Response of an academic medical center and a public safety net hospital in California

A narrative review of the pathophysiology of COVID‐19 infection among cancer patients: Current evidence and research perspectives

Contact Info

Product

Resources

About