Correlates of intention-to-attend and confirmed cervical screening attendance during the COVID-19 pandemic in Australia: Findings from Compass-PLUS, a prospective cohort study.

Objective: The coronavirus pandemic impacted health-seeking behaviour and access to primary care in Australia. We investigated factors associated with intention-to-attend and attendance of cervical screening during the pandemic, mainly in Victoria, Australia.
Methods: We used questionnaire and attendance data (Aug 2020-Nov 2022) from Compass-PLUS, a sub-study of the Compass randomized-controlled trial of Human Papillomavirus-based vs cytology-based screening. Data was restricted to the HPV-screening arm for comparability to the national program. We investigated associations overall and for younger (25-39 years) and older (≥40 years) cohorts, between intention-to-attend/attendance, and socio-demographics, anxiety-related scores, and agreement with beliefs about screening during the pandemic (e.g. importance of screening, increased workload, working from home, risk of infection).
Results: Among 2,226 participants, positive intention to attend screening was more likely among those with a family history of cancer (p = 0.030) or living outside major cities (p = 0.024). Increased attendance was associated with increasing age (p < 0.001), prior regular cervical screening history [adjusted relative risk (aRR) for 2 screens in 6 years vs none: 1.23 (95 %CI 1.09,1.40); p < 0.001], and part-time employment or retirement compared to full-time employment [aRR:1.08 (1.02,1.14); aRR:1.12 (1.03, 1.22); respectively]. Lower attendance was related to increased agreement with statements indicating screening de-prioritisation (p-trend < 0.05) and higher recent anxiety, specifically in the older cohort (p-trend = 0.002).
Conclusions: Reduced priority of screening and heightened recent anxiety may partly explain indications of lower-than-expected cervical screening rates during the pandemic. It is important that catch-up of missed HPV screens is performed to prevent a possible increase in cancer diagnoses in the long term.
Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KC and MS are co-PIs of an investigator-initiated trial of cervical screening, (Compass; ACTRN12613001207707 and NCT02328872) run by the Australian Centre for the Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity; ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics. KC, MS and DB are also co-PIs on a major investigator-initiated implementation program Elimination of Cervical Cancer in the Western Pacific (ECCWP) which receives support from the Minderoo Foundation, and equipment donations from Cepheid Inc. Neither KC, MS, nor their institutions have received direct funding from industry for any project. MS holds NHMRC grants for 5 projects, is the Director for Cancer Council Australia and Co-chair of HPV test characteristics expert panel and consultant for Cancer Care Ontario. MS’s institution, ACPCC, received donated HPV testing equipment for research purposes from the following companies: Roche, Seegene, Abbott, Becton Dickinson, Cepheid, AusDiganostics, Copan, Qiagen and Atila Biosystems. MAS reports salary support via fellowship grants from the NHMRC of Australia and Cancer Institute NSW and contracts paid to her institution (the Daffodil Centre) with the Commonwealth Department of Health (Australia) and National Screening Unit (New Zealand). The remaining authors have no conflicts of interests to declare.
(© 2024 The Authors. Published by Elsevier Inc.)