In March this year COVID-19 brought the country to a standstill and all screening services were paused. The New Zealand cervix, blissfully unaware of the virus, was left to its own devices for a month with potentially far reaching consequences.
By the end of May, New Zealand was 50,239 cervical screens in debt compared with the same period in 2019. Troubling.
Standing up to meet the need, primary care has done a fantastic job increasing the numbers of women screened. In June and July 2020, we screened 15,256 more people than the same period in 2019.
We can give ourselves a ‘pat on the back’ and give our nursing team and screeners an air ‘high five’ or a ‘corona foot tap’ - we are on the road to recovery.
We know New Zealand has an equity gap in the screening programme. Consistently Māori, Pacific and Asian women have less cytology done than other women in New Zealand.
When COVID-19 part two hit the country, the gains from June and July were eaten away. The gap between the cervixes we were seeing or not seeing started to increase, and Māori, Pacific and Asian cervixes need some screen time.
Modelling done by the Cancer Council in Australia suggests the decrease in screening will result in an increase in cancer diagnoses of 1.1-3.6% between 2020 and 2022. They suggested the largest increases in cancer diagnoses would be among women aged 30-39 years and 40-49 years.
While this modelling is specific to the Australian population, there are likely to be similar ramifications here in New Zealand which will most likely be felt by Māori, Pacific and Asian populations.
So where to from here?
There is ongoing robust discussion around HPV self-screening as the answer to many problems. However, this is not an answer to any of the multitude of issues we are facing, at least in the short-term.
The technical infrastructure required to support the switch from cytology to HPV self-screening doesn’t exist yet. If we switched tomorrow, the existing infrastructure couldn’t keep our women safe.
We have a good screening programme. We need to continue doing what we are doing and keep doing it well. We also need to do more of it.
We need to always remember the inequities that are present in our society and keep our patients first.