MMWR Morb Mortal Wkly Rep. 2021 Jan 29;70(4):109-113. doi: 10.15585/mmwr.mm7004a1.
On March 19, 2020, the governor of California issued a statewide stay-at-home order to contain the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* The order reduced accessibility to and patient attendance at outpatient medical visits, including preventive services such as cervical cancer screening. In-person clinic visits increased when California reopened essential businesses on June 12, 2020. Electronic medical records of approximately 1.5 million women served by Kaiser Permanente Southern California (KPSC), a large integrated health care system, were examined to assess cervical cancer screening rates before, during, and after the stay-at-home order. KPSC policy is to screen women aged 21-29 years every 3 years with cervical cytology alone (Papanicolaou [Pap] test); those aged 30-65 years were screened every 5 years with human papillomavirus (HPV) testing and cytology (cotesting) through July 15, 2020, and after July 15, 2020, with HPV testing alone, consistent with the latest recommendations from U.S. Preventive Services Task Force. Compared with the 2019 baseline, cervical cancer screening rates decreased substantially during the stay-at-home order. Among women aged 21-29 years, cervical cytology screening rates per 100 person-months declined 78%. Among women aged 30-65 years, HPV test screening rates per 100 person-months decreased 82%. After the stay-at-home order was lifted, screening rates returned to near baseline, which might have been aided by aspects of KPSC's integrated, organized screening program (e.g., reminder systems and tracking persons lost to follow-up). As the pandemic continues, groups at higher risk for developing cervical cancers and precancers should be evaluated first. Ensuring that women receive preventive services, including cancer screening and appropriate follow-up in a safe and timely manner, remains important.
2020 年 3 月 19 日,加利福尼亚州州长发布全州范围的居家令,以控制导致 2019 年冠状病毒病(COVID-19)的 SARS-CoV-2 病毒传播。*该命令减少了门诊医疗访问的可及性和患者就诊率,包括宫颈癌筛查等预防服务。2020 年 6 月 12 日加利福尼亚州重新开放必要业务后,门诊就诊人数增加。对 Kaiser Permanente Southern California(KPSC)的约 150 万名妇女的电子病历进行了检查,以评估居家令前后的宫颈癌筛查率。KPSC 的政策是,对 21-29 岁的女性每 3 年单独进行一次宫颈细胞学检查(巴氏涂片[Pap]试验)筛查;对 30-65 岁的女性每 5 年进行一次人乳头瘤病毒(HPV)检测和细胞学检查(联合检测),截至 2020 年 7 月 15 日,之后采用 HPV 检测,符合美国预防服务工作组的最新建议。与 2019 年基线相比,居家令期间宫颈癌筛查率大幅下降。在 21-29 岁的女性中,每 100 人-月的宫颈细胞学筛查率下降了 78%。在 30-65 岁的女性中,HPV 检测筛查率每 100 人-月下降了 82%。居家令解除后,筛查率恢复到接近基线水平,这可能得益于 KPSC 综合、有组织的筛查计划的某些方面(例如,提醒系统和跟踪失访人员)。随着大流行的继续,应首先评估患宫颈癌和癌前病变风险较高的人群。确保妇女以安全和及时的方式获得包括癌症筛查在内的预防服务仍然很重要。
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