Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco (UCSF), United States of America; Obstetrics, Midwifery and Gynecology Clinic, Zuckerberg San Francisco General Hospital and Trauma Center, United States of America.
Department of Family and Community Medicine, UCSF, United States of America.
Prev Med. 2021 Oct;151:106569. doi: 10.1016/j.ypmed.2021.106569. Epub 2021 Jun 30.
The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.
快速诊断和治疗高级别宫颈前病变是预防宫颈癌的基础。然而，在 COVID-19 大流行期间，医疗系统有时会将门诊限制在那些被认为紧急的患者。专业协会为临床医生提供了一些关于如何修改传统宫颈癌筛查的指导，但仍存在许多空白。为了解决这些空白，加利福尼亚州一所学术医疗中心和一家城市社区医院的筛查项目负责人成立了一个快速行动委员会，为其从业者提供指导。患者被分为 6 类，对应筛查过程的各个阶段，并根据潜在高级别宫颈前病变和癌症的风险进行排名。根据当地大流行的强度构建了相应的级别，并随着级别的上升，为风险最低的患者延长了临床延迟。最终的产物是一个管理网格，旨在随着 COVID-19 大流行的当地流行病学变化而升级和降级。虽然这一努力导致了临床筛查服务的实质性延迟，正如医疗系统所要求的那样，但延迟对宫颈癌结果以及与减少严重急性呼吸冠状病毒 2 传播相关的有益效果的人群影响尚未阐明。
