About 90% of the estimated cervical cancer deaths occur in low and middle-income countries. In Brazil, cervical cytology (i.e Pap smear) is a widely used strategy for its early detection. Considering the crucial role of the primary care in women’s health in Brazil and the COVID-19 pandemic related health crisis, this cross-sectional study aimed to analyze the repercussions of the COVID-19 pandemic in cervical cancer screening in a teaching Basic Health Unit (BHU) from South of Brazil, in the city of Pelotas.
This study was approved by the institutional ethics committee (5.706.229). We analyzed records of Pap smears performed between February 2019 to February 2020 and March 2020 to April 2022, referred to as pre-pandemic and pandemic period. The statistical analysis was performed using the Statistical Package for the Social Sciences program.
The sample mean age was 43.6 years and they were mostly residents of the area covered by the BHU (94.35%). During the pre-pandemic and pandemic period 339 and 653 exams were collected, respectively. A 42% reduction in tests performed in 2020 compared to 2019 was observed as well as an increase of 107% in 2021 compared to 2020. An increase was assessed in the rate of non-residents (of the area of responsibility of the BHU) performing Pap tests in the Unit during the pandemic period (p = 0.001). Most of the results were negative for intraepithelial lesion or malignancy (NILM). A significant difference in abnormal results in the pre-pandemic and pandemic period, respectively, was seen (p = 0.012) (table 1).
Table 1: Association between the pre-pandemic and COVID-19 pandemic period and Pap smears results.
| Pre-pandemic period N (%) | Pandemic period N (%) | P value | |
| Residents of the area covered by the BHU* | 0.001 | ||
| Yes | 328 (97) | 608 (95) | |
| No | 10 (3) | 30 (5) | |
| Cervical cytology* | |||
| NILM | 306 (95.6) | 567 (91.0) | 0.012 |
| Abnormal | 14 (4.4) | 56 (9.0) | 0.012 |
*Variables with data missing
The crisis brought on by the COVID-19 pandemic may have exacerbated pre-existing health disparities in cervical cancer already present in Brazil in pre-pandemic periods. Recovery strategies in primary care are needed to prioritize high-risk patients and lessen the burden of cervical cancer in the future.