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Delivering cervical cancer screening during the COVID-19 emergency
  1. Cecilia Acuti Martellucci1,
  2. Margherita Morettini2,
  3. Maria Elena Flacco1,
  4. Lamberto Manzoli1,
  5. Matthew Palmer3,
  6. Giusi Giacomini2,
  7. Francesca Pasqualini2
  1. 1 Department of Medical Sciences, University of Ferrara, Ferrara, Italy
  2. 2 Department of Prevention, Oncologic Screening Unit, Health Agency of the Marche Region, Ancona, Italy
  3. 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
  1. Correspondence to Dr Cecilia Acuti Martellucci, Department of Medical Sciences, University of Ferrara, Ferrara 44121, Italy; cecilia.martellucci{at}

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Key messages

  • During the SARS-CoV-2 pandemic, conventional cervical cytology (Pap smear) screening flexible-timing invitations were changed to fixed-timing invitations to ensure social distancing.

  • Due to the scheduling change, the number of tests conducted per hour decreased from 4.1 (July–December 2019) to 3.6 (July–December 2020).

  • Nevertheless, the lockdown backlog was successfully addressed through a substantial, but sustainable, reorganisation of obstetrician activities, obtaining performances comparable to 2019.

Why was change needed?

By the end of January 2021, almost 100 million people were infected with SARS-CoV-2 and over two million had died.1 Disruptions in healthcare delivery occurred in most countries as a direct consequence of the pressures posed by overwhelming numbers of COVID-19 cases, and as an indirect effect of strict infection containment measures such as social distancing and lockdowns.2

Italian regions halted cervical screening programmes in March 2020, for about 4 months, when only follow-up colposcopies were guaranteed.3 In the province of Ancona, primary conventional cervical cytology (Pap smear) screening was suspended from 9 March to 30 June 2020 as its organisation did not guarantee social distancing.4 Indeed, the programme was based on flexible-timing invitations: assuming an average 50% participation, more women than the available time slots were invited, without strict timings or having to confirm their appointment.5 This implied the possibility of overcrowding in waiting rooms.

The pandemic posed a double challenge: while flexible-timing was eliminated to ensure social distancing, a greater number of tests was needed to clear the 16-week backlog. The adopted strategies differed greatly across Italian regions: several already used fixed appointments (with a precise date and time in the invitation letter, in accordance with national recommendations)6 and only had to allocate more time for each test in order to avoid overcrowding. Most of the other regions, which used flexible-timing, moved to fixed appointments, and some programmes required the women …

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  • CAM and MM are joint first authors.

  • Contributors CAM and MM collected and analysed data, and drafted the manuscript. MEF, MP and GG assisted with the literature review and the critical appraisal of the manuscript. LM and FP assisted in drafting and critically appraising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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