The effect of healthcare disruptions during the COVID‐19 pandemic on colposcopy services and practice: A systematic review and meta‐analysis

Introduction: The healthcare reorganization during the COVID-19 pandemic affected colposcopy services and cervical cancer prevention, particularly in those countries where healthcare systems were already under-resourced. This review aimed to quantify the reduction in colposcopy services across countries during the COVID-19 pandemic and to determine whether the data source per study and cervical cancer screening coverage per country influenced the extent of these reductions. Material and Methods: Studies reporting comparative data on colposcopy services between the COVID-19 pre-pandemic and pandemic period were included. MEDLINE, Embase, EMCare, Covid-19 Research, British Nursing Index, APA PsycINFO, and Allied and Complimentary Medicine databases were searched for studies published from March 2020 to December 2023. The Newcastle−Ottawa scale was used for risk of bias assessment. The number of colposcopies, cervical treatments, pre-invasive lesions diagnoses, and cervical cancer diagnoses per month were compared between the pre-pandemic (before March 2020) and pandemic period (after March 2020). The effect measure was the standardized mean difference. Heterogeneity was evaluated with the chi-squared test and quantified with the I2 method. A meta-regression was performed, considering the data source (regional/national databases/registries or institutional databases) and the screening coverage according to World Health Organization data (≥70% or <70%) as moderators. The review was registered on PROSPERO (CRD42023447188). Results: Thirteen studies were included. Twelve were of good/high quality according to the Newcastle−Ottawa scale. The standardized mean difference between the pre-pandemic and pandemic periods was −1.60 (95% CI −2.49 to −0.72, p = 0.004) for colposcopies (4 studies, I2 = 60.97%, p = 0.075), −1.70 (95% CI −2.50 to −0.90, p < 0.001) for cervical treatments (5 studies, I2 = 52.92%, p = 0.081), −4.61 (95% CI -7.90 to −1.33, p = 0.006) for pre-invasive lesion diagnoses (4 studies, I2 = 92.45%, p < 0.001), and −0.85 (95% CI −1.52 to −0.19, p = 0.012) for cervical cancer diagnoses (9 studies, I2 = 71.07%, p = 0.002). At meta-regression, further reductions for cervical treatments and pre-invasive lesion diagnoses were observed in the case of screening coverage <70%. Conclusions: During the COVID-19 pandemic, a reduction in colposcopies, cervical treatments, pre-invasive lesions diagnoses, and invasive cancer diagnoses was observed. Since a screening coverage of <70% heightened these declines, increasing such coverage could lead to better resilience of cervical cancer prevention services to future crises.