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Incidence of pre-neoplastic and neoplastic lesions of the cervix before and after the COVID-19 pandemic
  1. Miriam Dellino1,
  2. Marco Cerbone1,
  3. Francesca Fortunato2,
  4. Teresa Capursi1,
  5. Achiropita Lepera1,
  6. Tiziana Mancini1,
  7. Antonio Simone Laganà3,
  8. Antonio Malvasi1,
  9. Paolo Trerotoli4,
  10. Gennaro Cormio1,5,
  11. Ettore Cicinelli1,
  12. Gerardo Cazzato6,
  13. Carmine Carriero1,
  14. Vincenzo Pinto1,
  15. Eliano Cascardi6 and
  16. Amerigo Vitagliano1
  1. 1Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
  2. 2Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  3. 3Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
  4. 4Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Puglia, Italy
  5. 5Department of Gynecology, University of Bari, Bari, Puglia, Italy
  6. 6Section of Molecular Pathology, Department of Precision and Regenerative Medicine and IonianArea (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy, Bari, Puglia, Italy
  1. Correspondence to Dr Miriam Dellino, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy; miriamdellino{at}hotmail.it

Abstract

Objective The COVID-19 pandemic had significant effects on healthcare systems worldwide, including the disruption of routine screening programs for cervical cancer. This study aimed to compare the incidence of cervical intra-epithelial neoplasia (CIN)2 and CIN3 lesions, adenocarcinoma, and squamous carcinoma of the cervix before and after the COVID-19 pandemic.

Methods A retrospective analysis was performed using archive data from the Policlinico di Bari, Unit of Gynecology and Obstetrics. The study included patients who tested positive for high-risk human papillomavirus (HPV) at the level I screening test (HPV test) and were subsequently referred to level II screening, which involves the Papanicolaou (Pap) test and colposcopic examination. We excluded individuals who did not comply with the recommended follow-up, patients with low-risk HPV infection, those with autoimmune diseases, oncologic diseases, or those undergoing immunosuppressive therapies. The time period spanned from January 2020 to December 2022. The incidence of CIN2/CIN3 lesions, adenocarcinoma, and squamous carcinoma of the cervix was compared between the pre-screening period (2017–2019) and the post-screening period (2020–2022).

Results The study comprised a cohort of 1558 consecutive European sexually active women with a median age of 34 years (range 25–65) who underwent colposcopic evaluation of the uterine cervix as a level II screening program. The comparison between the pre-screening and post-screening periods showed an increase in the incidence of CIN2/CIN3 lesions, rising from 23.9 to 63.3 per 100 000 (HR 2.62, 95% CI 1.64 to 4.20; p<0.001). Additionally, although there was an absolute increase in the incidence of cervical carcinoma and adenocarcinoma, the comparison did not reach statistical significance (squamous carcinoma: 2017–2019, 2.5 per 100 000; 2020–2022 3.4 per 100 000, p=0.72; adenocarcinoma: 2017–2019, 3.5 per 100 000; 2020–2022 7.6 per 100 000, p=0.24).

Conclusion This study showed a significant increase in the incidence rate of CIN2/CIN3 lesions after the COVID-19 pandemic. Our findings may be attributed to the temporary suspension of follow-up programs during the pandemic, although the study does not rule out direct effects of SARS-CoV-2 on the risk of pre-neoplastic and neoplastic conditions of the cervix.

  • Cervical Cancer
  • COVID-19

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • EC and AV are joint senior authors.

  • EC and AV contributed equally.

  • Contributors Conceptualization: MD, ECa, AV. Methodology: MD. Software: PT. Validation: FM, GCa. Formal analysis: PT, AM. Investigation, MC, FM. Data curation: AL, TM. Writing—original draft preparation: MD, ECa, MC. Writing—review and editing: ASL, GCo, GCa, CC. Supervision: ECi, ASL, VP, AV. All authors have read and agreed to the published version of the manuscript. MD is responsible for the overall content as guarantor.

  • Funding None

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.