The diversion of clinical resources caused by the COVID-19 pandemic led to a decline in the number of US individuals getting screened for cancer in 2020, according to an article published by Oncology.

Vose JM. Delay in cancer screening and diagnosis during the covid-19 pandemic: what is the cost? Oncology. 2020;34(9).

 

 

Pandemic led to declining numbers

A cohort study published in JAMA Oncology found that there was a screening deficit of approximately 9.4 million people in the US in 2020 due to the COVID-19 pandemic.

Chen RC, Haynes K, Du S, et al. Association of cancer screening deficit in the US with the COVID-19 pandemic. JAMA Oncol. 2021;7(6):878–884.

 

Researchers utilized the HealthCore Integrated Research Database, which has information on around 60 million people enrolled in Medicare Advantage and commercial health insurance plans.

Study participants were individuals found in the database from January to July of 2018, 2019, and 2020 who did not have a diagnosis of breast, colorectal, or prostate cancer.

Investigators found that for all three cancers, there was a sharp decline in screenings in March through May 2020 compared with the same period in 2019, with the biggest decrease occurring in April 2020.

Deficits in cancer screening were estimated to be 3.9 million for breast cancer, 3.8 million for colorectal cancer, and 1.6 million for prostate cancer. By July 2020, however, researchers observed a near-complete recovery of screening rates for breast and prostate cancers.

 

Effects of decreased testing

The decrease in cancer screening rates that occurred during the COVID-19 pandemic had a measurable impact on the incidence of cancer diagnoses, leading to a 65.2% drop in new cancer diagnoses in April 2020, according to the Oncology research.

The number of patients with a new diagnosis of lung cancer dropped by approximately 50% from January to April 2020 in comparison with 2019 figures for those months. For melanoma, this number was 67.1% over the same time period.

To quantify the impact of delayed screenings on cancer survival rates, investigators in England utilized data from the National Health Service to model changes in death rates for four major types of cancer. They published their results in Lancet Oncology.

Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020;21(8):1023–1034.

 

The researchers found an increase of approximately 7.9% to 9.6% in the number of deaths from breast cancer up to 5 years post-diagnosis compared with pre-pandemic data. For colorectal and lung cancer, increases of 15.3%–16.6% and 4.8%–5.3% were observed, respectively.

 

A silver lining?

Despite such findings, the impact of the COVID-19 pandemic on cancer screening may ultimately yield some positive outcomes.

“We’ve learned some things during the pandemic that could lead to better screening practices in the future,” Jennifer Haas, MD, of Massachusetts General Hospital, noted in an article published by the National Cancer Institute (NCI).

Winstead E. For cancer screening, COVID-19 pandemic creates obstacles, opportunities. National Cancer Institute. March 10, 2021.

 

The pandemic boosted the use of home-based screening tests, particularly the fecal immunochemical test (FIT) for colorectal cancer screening, in which a patient collects a stool sample and sends it to a laboratory for testing.

In fact, as reported in an article published in Gastroenterology, a screening facility in the Western US was able to maintain high screening rates during April–May 2020, as in-person cancer screening rates dropped, by continuing to mail FIT kits to patients for colorectal screening.

The National Cancer Institute’s PROSPR Consortium; Corley DA, Sedki M, Ritzwoller DP, et al. Cancer screening during the coronavirus disease-2019 pandemic: A perspective from the National Cancer Institute’s PROSPR Consortium. Gastroenterology. 2021;160(4):999–1002.

 

FIT could be a model for developing other cancer screening tests.

Home-based screening tools are being investigated for cervical cancer, but they have yet to be approved by the US FDA.

 

Ideas to boost cancer screening

To develop a strategy for getting people to resume cancer screening, the NCI’s Population-based Research to Optimize the Screening Process (PROSPR) consortium offered some practical recommendations:

1. Broader use of remote testing, such as mailed FIT tests for colorectal cancer screening, which will reduce the need for in-person visits in some cases

2. Outreach programs for individuals at the highest social risk of cancer who tend not to seek screening

3. Development of COVID-19 control strategies to alleviate patient concerns about going to screening facilities

4. Using risk stratification tools to identify individuals at the highest medical risk of cancer

5. Development of tools to identify disparities in cancer screening early