Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Cervical Cancer Screening in Gynecological Practices in Germany

Simple Summary The outbreak of the coronavirus disease 2019 (COVID-19) is a major challenge for healthcare systems and impedes cancer screening programs worldwide. However, no research has been performed that analyzes the effects of the COVID-19 pandemic on the newly implemented German Cervical Cancer Screening (CCS) program. Here, we showed a severe clinically relevant decrease of patients receiving CCS in Germany between the pre-pandemic time period of 2018-2019 and the pandemic years of 2020-2021. Given that this sudden drop in number of CCS per practice is unlikely, our data suggest a dramatic number of underdiagnosed cervical precancer lesions that may lead to increased cervical cancer burden in the future. Purpose: the aim of this cross-sectional study was to analyze the impact of the COVID-19 pandemic on Cervical Cancer Screening (CCS) in gynecological practices in Germany. Methods: The basis of the analysis was the Uniform Evaluation Standard (EBM) of the Statutory Health Insurance Scheme. This cross-sectional study included all women aged >= 20 years with at least one CCS (clinical and cytological examination) in 223 gynecological practices in Germany during the period 2018-2021. The number of patients with CCS per practice was shown for each year. The average number of patients per year was compared between the pre-pandemic time period (2018, 2019) and the pandemic time period (2020, 2021) using Wilcoxon tests. Analyses were conducted separately for clinical investigations and cytological investigations and were also stratified by age group (20-34, 35-50, >50 years). Results: CCS in gynecological practices significantly decreased in Germany between the pre-pandemic time period of 2018-2019 and the pandemic years of 2020-2021. This decrease was observed in all age groups but was stronger in women aged 20-34 (-25.6%) and weaker in women aged >50 (-15.2%). Conclusions: We found a statistically and clinically relevant decrease of patients receiving CCS in gynecological practices in Germany. This finding is even more exceptional because the new screening algorithm with direct invitations for each patient started in 2020 and was supposed to lead to a higher number of patients in its first years. However, the observed decline in the detection of cervical precancer lesions may lead to increased cervical cancer burden. Risk-based screening strategies and further measures are necessary to adapt to the ongoing COVID-19 pandemic and return to pre-pandemic CCS numbers.