Impact of the covid-19 pandemic on cervical cancer screening in saopaulo state, brazil

INTRODUCTION: The early identification of precursor lesions followed by appropriate treatment prevents development of cervical cancer and its consequences OBJECTIVE: The present study evaluated the influence of the Covid-19 pandemic on cervical cancer screening by comparing the quantity of tests to detect cervical cellular changes performed in Sao Paulo state in 2019, prior to the detection of SARS-CoV-2 in Brazil, to the first (2020) and second (2021) years following its appearance. MATERIALS AND METHODS: Data from Fundacao Oncocentro de Sao Paulo (FOSP), the agency that analyses approximately 220,000 Pap tests annually, was reviewed. RESULTS: A median of 1835 Papanicolaou (Pap) tests were performed in 55 municipalities in 2019. This was reduced to 815 tests in 2020, a 56% decrease (p = 0.0026). In 2021, the median number was 1745, a 53% increase over 2020 levels (p = 0.0233). The 26 municipalities with >1000 tests in 2020 had a median reduction from 4433 in 2019 to 2580 in 2020 (p = 0. 0046). The 29 municipalities with <1000 tests had a median reduction from 951 in 2019 to 554 in 2020 (p < 0.0001). There was a 44% reduction in the number of follow-up cytological evaluations from 2019 to 2020, followed by a 30% increase the following year. However, the percentage of women with a normal finding or with any abnormality remained unchanged. The findings from a histological evaluation of women in Sao Paulo city indicated that the percent of cases positive for CIN-1 (p<0.0410) and CIN-3 (p<0.0012) increased in 2020 and 2021 as compared to 2019 levels. CONCLUSION: A reduction in testing for cervical cancer in the first year of the Covid-19 pandemic, accompanied by an elevated incidence of precancerous lesions in each of the first two years following its initiation, may portend a subsequent increased occurrence of cervical cancer in Brazil.