Cancer screenings declined dramatically during the height of the COVID-19 pandemic.
The screening deficit led to a notable drop in new cancer diagnoses.
Recommendations to help close the cancer screening gap include broader implementation of home-based screening tests and targeting of individuals at increased risk of cancer through outreach programs.
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.
Out of concern that this decline in screenings could have long-term, negative repercussions on the diagnosis of new cancers and survival for patients with cancer, experts have offered ideas to help boost the number of people getting screened.
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.
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.
Researchers have been concerned that such decreases in cancer diagnoses might mean that more patients will be diagnosed at later stages of cancer, which could decrease their overall survival rates.
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.
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).
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.
"FIT could be a model for developing other cancer screening tests."
— Jennifer Haas, MD, in NCI article
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:
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
Outreach programs for individuals at the highest social risk of cancer who tend not to seek screening
Development of COVID-19 control strategies to alleviate patient concerns about going to screening facilities
Using risk stratification tools to identify individuals at the highest medical risk of cancer
Development of tools to identify disparities in cancer screening early
What this means for you
During the COVID-19 pandemic, there were sharp declines in cancer screening rates, leading to a drop in new cancer diagnoses and a potential increase in cancer-related deaths. Clinicians can help overcome this deficit by staying up to date on screening guidelines and discussing the importance of screening with patients—especially those who may be at increased social or medical risk of developing cancer.
Caring During COVID speaks directly to clinicians who are still facing the realities of the pandemic. Each week we feature perspectives, lessons, research, guidance, and more. Submit any question or topic you'd like to see covered, and let us know if you’d like to be a guest author.