Impact of COVID-19 on cervical screening

To further our work in understanding the impact of COVID-19 on cervical screening, we conducted an online survey of 2,000 women aged 25-64 living in England and spoke to an additional 22 through one to one interviews and focus groups. Carried out during June and July 2020, we asked those taking part in the research how they felt about attending cervical screening in light of the pandemic.

What we found 

It was positive that 48% said the pandemic had not affected how they would feel about attending cervical screening with 12% feeling more likely to attend. Concern was expressed at screening being paused or delayed in some areas due to the pandemic, with many eager to attend. 

While the majority of participants felt less anxious about the virus than at the start of the pandemic, one in 10 (9%) said they definitely wouldn’t attend cervical screening now and 22% felt less likely to attend. Higher levels of fear or concern was found among those who have been shielding or living with someone shielding, women from Black, Asian and minority ethnic backgrounds and those overdue screening. 

It has been widely reported that people from ethnic minority backgrounds have potentially higher risk of COVID-19, so it is not surprising this is leading to anxiety or concern about attending cervical screening. We found among women from Black, Asian and minority ethnic backgrounds:

• 43% say they definitely wouldn’t attend cervical screening or feel less likely to attend
• There is increased worry about contracting the virus at a screening than among white women (20% v 9.4%)
• A third more likely (39.6%) to feel unsafe visiting a doctor’s surgery at the moment than white women (27.2%)
• More than twice (17.3%) as likely as white women (8.1%) to believe that delaying screening is the safest thing to do at the moment.

Understanding the worries

Cervical screening is the best protection against cervical cancer, so we must focus on providing the information and support people need to feel confident and safe to attend.

The overarching finding was that among most women, catching COVID-19 is not the main concern, yet it is a source of additional worry. When asked about screening in general 59% said they don’t like it but see it as a necessary test. 29% say it makes them anxious, 27% find it embarrassing and 21% find it painful. Negative sentiments were all more prevalent among women overdue screening.

Worries about the safety of visiting a GP surgery were high, with 29% saying they don’t feel it is safe to visit a GP surgery at the moment and 36% feeling anxious about their safety (or safety of someone they live with). Concern about inadvertently passing Covid-19 to loved ones, particularly for those in more at-risk groups, was generally greater than getting virus themselves. Encountering ‘unwell’ people in waiting rooms and having to get public transport were two of the biggest worries. Associated potential barriers that were mentioned include uncertainty about screening being available, expectation of backlogs and fewer appointments, not being able to make appointments online and having a male practitioner due to staff shortages.

The need for information about what will happen at cervical screening now and the safety measures would be in place is very high (51%) and his rises significantly among BAME women (69%).

43% of all respondents say more information or reassurance about safety measures would make them more likely to have a test if they were due, and 36% would be more likely if they knew the nurse would definitely be wearing a mask.

How can staff in primary care help? Here are our tips on how to address concerns:

1. Alert women to the availability of screening – do they know they can book a test?
2. Consider the information and support that patients, especially those in higher risk groups, might need to feel more comfortable with attending
3. Provide upfront information on what to expect, being clear that the NHS and your surgery are following guidelines to keep people safe. This could be through a phone call when contacting those who are overdue, when patients book in, or using websites and social media to communicate what you are doing
4. Explain what patients can do themselves ahead of an appointment to feel safe, such as wearing a mask and keeping a safe distance when travelling
5. Consider how to engage those who may be less likely to attend as a result of the pandemic, or who may have increased barriers. The pandemic means outreach work, educational events or awareness sessions, literature that may be displayed in community settings or workplaces, and other initiatives may have paused or stopped
6. Remain mindful of the barriers to screening that existed before the pandemic – psychological, physical, literary and cultural. These have not gone away and instead patients are likely to be feeling more anxious than before
7. Try to work with patients to find alternatives to things no longer available due to the pandemic, for example for those who would want to bring someone with them
8. Remember we are here, with information and support for you and your patients