Primary and secondary prevention of cervical cancer during the COVID-19 pandemic in Sao Paulo State, Brazil

Abstract

Cervical cancer remains an important public health problem. Prevention relies on vaccination against human papillomavirus (HPV) and Pap smears for early detection of precursor lesions. Both strategies should be implemented at appropriate intervals. However, the COVID-19 pandemic led to delays in preventive care, which may have negatively impacted cervical cancer (CC) indicators. Therefore, this study aims to assess the impact of the pandemic on the CC prevention program in Sao Paulo State, Brazil, using data from a public health database. An ecological study was conducted using quantitative data on HPV vaccination and Pap smears obtained from DATASUS between 2016 and 2021. Municipalities were grouped into clusters according to population size and their performance during 2020 and 2021 (increase or decrease in preventive services) and were compared according to socioeconomic variables. HPV vaccination rates increased in 2020, but this trend was not sustained in 2021. Regarding Pap smears, most municipalities experienced a decline in 2020, followed by an increase in 2021. Municipalities with the poorest socioeconomic indicators struggled to recover in 2021. The number of COVID-19 cases was not strongly associated with variations in preventive practices. CC prevention strategies were affected by the drop in HPV vaccination in 2021 and the postponement of routine screening during the most critical period of the pandemic, especially in the most vulnerable municipalities, which experienced a slower recovery. These findings suggest that the Brazilian healthcare system faced great challenges in both maintaining and restoring preventive care during a public health crisis.