The feasibility and necessity of cancer screening events in the community during the COVID-19 pandemic in Taiwan

In December 2019, a cluster of unidentified pneumonia cases in Wuhan, China, turned out to be caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), ¹ and the disease caused by SARS-CoV-2 has been termed coronavirus infectious disease 2019 (COVID-19). ²

In Taiwan, a cancer screening event in the community refers to when four cancer-related examinations are conducted: mammography (for women aged 45–69, and 40–44 for those at high risk), cervical smear (for women aged >30 with sexual experience), oral mucosa examination by trained physicians (for those aged >30 who smoke or chew betel nut), and fecal occult blood detection (for those aged 50–75). ³ The aim of these events is to improve accessibility and willingness to participate. The American Society of Clinical Oncology suggested that cancer screening procedures such as mammograms and colonoscopy that require hospital visits should be postponed during the COVID-19 outbreak, and that clinical teams should carefully assess the risks and benefits of elective procedures. ⁴ Reducing community transmission of the disease during outdoor cancer screening events also had to be considered. Below, we describe our strategies to mitigate the spread of COVID-19 during cancer screening events in the community.

The Public Health Centers in Kaohsiung City assess the risk and decide whether to hold a cancer screening event based on the following criteria: (1) ability to gain information on the participants beforehand; (2) air ventilation and replacement; (3) distance between participants; (4) whether the participants are in a fixed position; (5) event duration; and (6) hand hygiene and surgical masks.^5,6

All participants have to wear a medical mask, and their hands are sprayed with 75% alcohol before and after the examinations. The body temperature of all participants is also checked using a forehead thermometer, and they are not permitted to undergo an examination if their temperature is >37.5 °C. People must keep a distance of at least 1.5 m from each other in an indoor environment and 1 m if outdoors. Additionally, travel histories are identified through National Health Insurance cards using a database integrating the National Health Insurance Administration and National Immigration Agency.^6,7 The screening examinations performed at each event are as listed above, but excluding the oral examination which was cancelled this year due to the pandemic.

All workers, including physicians, nurses, medical radiation technologists, and administration staff, have to monitor their body temperature and report every day whether or not they have respiratory symptoms. They are also required to wear personal protective equipment including medical masks, waterproof gowns, disposable gloves, and goggles. All staff should disinfect their hands before and after contact with each participant. The areas where the examinations are performed are well ventilated, and are thoroughly cleaned and disinfected with 75% alcohol before and after each participant receives an examination.

The total number of people undergoing cancer screening examinations in the community in Kaohsiung City was 24,351 in February to March 2019 and 17,945 in February to March 2020. Table 1 gives a detailed comparison between these periods for cancer screening events conducted by our hospital only. The number of events was lower in 2020 than in 2019 (15.8% decrease) because some events were cancelled after risk assessment for the COVID‐19 outbreak. However, the number of participants per event remained stable (6% decrease). The difference in the number of people undergoing mammography, cervical smear and fecal occult blood examination per event in 2020 compared to 2019 was –9.0%, –0.2%, and 3.1%, respectively. The stability of these results is because effective prevention policies in Taiwan resulted in a small number of local clusters of COVID-19, and people could receive cancer examinations in the community thereby avoiding having to enter a hospital. We rigorously follow all COVID‐19 prevention policies during every cancer screening event in the community, to prevent community transmission and protect both the staff and participants.

Table 1.

Comparison of cancer screening events in the community conducted by our hospital in February to March, 2019 and 2020.

	Feb–March 2019	Feb–March 2020	Difference between 2020 and 2019 (%)
Number of events	19	16	–15.8
Number of participants	1037	820	–20.9
Average participants/event	54.6	51.3	–6.0
Total number of people undergoing screening examinations for	2150	1701	–20.9
Mammography	761	584	–23.3
Cervical smear	766	643	–16.1
Fecal occult blood detection	545	474	–13.0
Oral examination	78	0	–100
Average number of screenings/event	113.2	106.3	–6.1
Mammography	40.1	36.5	–9.0
Cervical smear	40.3	40.2	–0.2
Fecal occult blood detection	28.7	29.6	3.1
Oral examination	4.1	0	–100

Maintaining regular cancer screening events in the community is difficult during the COVID-19 pandemic. We hope that reporting our experience and COVID‐19 prevention strategy will be helpful for cancer screening in other communities.