Impact of the COVID-19 pandemic on cervical cancer screening and cytological abnormalities: A hospital-based study with psychological correlates

Abstract Background and Objectives: Cervical cancer screening programs have significantly reduced the incidence and mortality associated with cervical carcinoma. However, the onset of the COVID-19 pandemic led to the abrupt suspension of routine healthcare services, resulting in delayed diagnoses and the emergence of advanced cervical lesions. Additionally, widespread psychological distress, stemming from uncertainty, social restrictions, and bereavement, further influenced healthcare-seeking behavior. This study aimed to evaluate the impact of the COVID-19 pandemic on cervical screening rates, patterns of abnormal cytology, and the psychological status of women attending a tertiary care center. Materials and Methods: An observational study was conducted among women attending the Gynecology Outpatient Department of our institute. Clinical, demographic, and cytological parameters were compared between the pre-pandemic (January 2019–February 2020) and pandemic (April 2020–May 2021) periods. The psychological status was assessed using a structured questionnaire-based Patient Fear Score (PFS) designed to evaluate anxiety and pandemic-related distress. Results: The mean age of presentation increased from 36.5 ± 5 years in the pre-pandemic period to 42.6 ± 10 years during the pandemic. Cervical smear submissions declined by 31% during the pandemic, accompanied by an 11.4% increase in abnormal epithelial lesions. High-grade lesions, including high-grade squamous intraepithelial lesion and squamous cell carcinoma, were proportionately higher in the pandemic period. Psychological assessment revealed that 83% of women had elevated PFS scores, indicating significant fear and anxiety, which was strongly associated with delayed healthcare-seeking. Conclusion: The COVID-19 pandemic substantially disrupted cervical cancer screening services, resulting in reduced smear uptake, an increased proportion of high-grade cervical lesions, and heightened psychological distress among women from both rural and urban populations. Strengthening routine cervical screening and implementing widespread human papillomavirus vaccination are essential to mitigate the long-term impacts of such disruptions in resource-limited settings like India.