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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 (SARSCoV-2), and the disease caused by SARS-CoV-2 has been termed coronavirus infectious disease 2019 (COVID-19). 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). 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. 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. 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. 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