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Inst. Med. trop. S. Paulo"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1590\/s1678-9946202668064","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:38:43Z","timestamp":1789731523000},"source":"Crossref","is-referenced-by-count":0,"title":["Primary and secondary prevention of cervical cancer during the COVID-19 pandemic in Sao Paulo State, Brazil"],"prefix":"10.1590","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9914-7622","authenticated-orcid":false,"given":"Thain\u00e1 Siqueira de","family":"Carvalho","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4181-760X","authenticated-orcid":false,"given":"Marcelo Alves","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7509-0861","authenticated-orcid":false,"given":"Jo\u00e3o Carlos","family":"Geber J\u00fanior","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9808-8642","authenticated-orcid":false,"given":"Sandra","family":"Lorente","sequence":"additional","affiliation":[{"name":"Instituto Adolfo Lutz,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0137-6678","authenticated-orcid":false,"given":"Carlos Dias","family":"Maciel","sequence":"additional","affiliation":[{"name":"Universidade Estadual Paulista,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6659-7186","authenticated-orcid":false,"given":"Amaro Nunes","family":"Duarte-Neto","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1053\/j.seminoncol.2020.12.002","article-title":"Cancer diagnosis in Brazil in the COVID-19 era","volume":"48","author":"Marques NP","year":"2021","journal-title":"Semin Oncol"},{"key":"ref2","series-title":"Decreto No 64.864, de 16 de mar\u00e7o de 2020. Disp\u00f5e sobre a ado\u00e7\u00e3o de medidas adicionais, de car\u00e1ter tempor\u00e1rio e emergencial, de preven\u00e7\u00e3o de cont\u00e1gio pelo COVID-19 (Novo Coronav\u00edrus), e d\u00e1 provid\u00eancias correlatas","year":"2020"},{"key":"ref3","series-title":"Nota t\u00e9cnica - DIDEPRE\/CONPREV\/INCA - 30\/3\/2020: detec\u00e7\u00e3o precoce de c\u00e2ncer durante a pandemia de COVID-19"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1604224","DOI":"10.3389\/ijph.2022.1604224","article-title":"Impact of the COVID-19 pandemic on human papillomavirus vaccination in Brazil","volume":"67","author":"Silva TM","year":"2022","journal-title":"Int J Public Health"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0246951","article-title":"Impact of COVID-19 pandemic on the utilization of routine immunization services in Lebanon","volume":"16","author":"Mansour Z","year":"2021","journal-title":"PLoS One"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"114","DOI":"10.11606\/s1518-8787.2020054003042","article-title":"COVID-19 and its impact on immunization programs reflections from Brazil","volume":"54","author":"Matos CC","year":"2020","journal-title":"Rev Saude Publica"},{"key":"ref7","first-page":"1","article-title":"Monitoramento das a\u00e7\u00f5es de controle do c\u00e2ncer do colo do \u00fatero","volume":"13","year":"2022","journal-title":"Inform Detec Precoce"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1159\/000529249","article-title":"Impact of the COVID-19 pandemic on cervical cancer screening in S\u00e3o Paulo State, Brazil","volume":"67","author":"Martins TR","year":"2023","journal-title":"Acta Cytol"},{"key":"ref9","first-page":"1","article-title":"Monitoramento das a\u00e7\u00f5es de controle do c\u00e2ncer do colo do \u00fatero","volume":"12","year":"2021","journal-title":"Inform Detec Precoce"},{"key":"ref10","series-title":"Popula\u00e7\u00e3o: Brasil"},{"key":"ref11","series-title":"Divis\u00e3o de Detec\u00e7\u00e3o Precoce e Apoio \u00e0 Organiza\u00e7\u00e3o de Rede. 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Orienta\u00e7\u00f5es sobre o funcionamento dos servi\u00e7os de vacina\u00e7\u00e3o do Sistema \u00danico de Sa\u00fade no contexto da pandemia de COVID-19"},{"key":"ref24","article-title":"Spatial, spatio-temporal, and origin-destination flow analyses of patients with severe acute respiratory syndrome hospitalized for COVID-19 in Southeastern Brazil, 2020-2021","volume":"65","author":"Palasio RG","year":"2023","journal-title":"Rev Inst Med Trop Sao Paulo"},{"key":"ref25","first-page":"1","article-title":"Impact of COVID-19 pandemic on cancer-related hospitalizations in Brazil","volume":"28","author":"Costa AM","year":"2021","journal-title":"Cancer Control"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00431-024-05910-y","article-title":"Recovery from HPV vaccination deficits caused by the COVID-19 pandemic in Germany a modeling study of catch-up HPV vaccination among adolescent girls","volume":"184","author":"Saxena 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\u00fatero","year":"2016","edition":"2"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"105747","DOI":"10.1016\/j.puhe.2025.105747","article-title":"Spatial-temporal analysis of cervical cancer screening and social and health indicators in Brazil","volume":"243","author":"Gomes ML","year":"2025","journal-title":"Public Health"},{"key":"ref32","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung H","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.puhe.2024.07.034","article-title":"Mortality due to cervical and breast cancer in health regions of Brazil impact of public policies on cancer care","volume":"236","author":"Nogueira MC","year":"2024","journal-title":"Public Health"},{"key":"ref34","first-page":"100689","article-title":"Cervical cancer screening coverage in the Americas region a synthetic analysis","volume":"30","author":"Fern\u00e1ndez-Deaza G","year":"2024","journal-title":"Lancet Reg Health Am"},{"key":"ref35","first-page":"229","article-title":"A review of cervical cancer incidence and disparities","volume":"112","author":"Buskwofie A","year":"2020","journal-title":"J Natl Med Assoc"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12905-016-0334-2","article-title":"Patterns of cervical cytological abnormalities according to the Human Development Index in the northeast region of Brazil","volume":"16","author":"Pinho-Fran\u00e7a JR","year":"2016","journal-title":"BMC Women's Health"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12939-023-01912-8","article-title":"Social determinants influencing cervical cancer diagnosis an ecological study","volume":"22","author":"Galindo JF","year":"2023","journal-title":"Int J Equity 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