COVID-19 screening disruptions could lead to more colorectal cancers, deaths
The COVID-19 pandemic disrupted colorectal cancer screening programs around the world.
To explore the impact of disruptions to cancer screening of all types, the COVID-19 and Cancer Global Modelling Consortium was established to inform responses to screening disruptions and guide policy makers and prevention practices during and after the pandemic.
Using well-established and validated decision models, we analyzed a variety of scenarios for CRC screening disruption in Australia, Canada and the Netherlands. What we found would apply to some degree anywhere that has CRC screening, including the U.S.
Our analysis included the impact of various lengths of disruption to CRC screening programs, as well as the reduced participation from individuals who avoided healthcare during the pandemic because they were afraid of getting COVID-19 or did not want to increase pressure on healthcare systems. We also considered the impact of two catch-up strategies to mitigate the long-term impact of these disruptions. We presented the results of our analyses during Digestive Disease Week 2021.
The models showed that without a catch-up process to screen people missed during the disruption, the incidence of CRC would increase between 0.1% and 1.2% through the year 2050 among individuals aged 50 and older, depending on the length of the disruption and the country. CRC-related deaths would increase by 0.2% to 2%. A 6-month disruption in screening would result in 3,552 additional CRC and 1,961 CRC-related deaths in Australia; 2,844 CRC and 1,319 CRC-related deaths in Canada; and up to 1,803 additional CRC and 881 CRC-related deaths in the Netherlands.
The good news is the additional CRC and CRC-related deaths could be reduced to nearly zero with a catch-up process that involves either screening those skipped during the disruption or slowing the pace of screenings to allow time to incorporate missed screenings.
In all three countries studied, routine screening begins with an at-home fecal immunochemical test (FIT). If the FIT is considered positive, a follow-up colonoscopy is scheduled. The U.S. has an opportunistic screening process, where screening through FIT and/or colonoscopy is recommended by a general practitioner, gastroenterologist or other professional. Any interruptions to screening could have similar long-term impact on CRC rates and deaths over the next 3 decades in the U.S., where in 2019, 155,000 CRCs were diagnosed, and 51,000 deaths were attributed to CRC.
While the increased CRC and CRC-related deaths might seem relatively small, it is imperative we avoid any increase in incidence and mortality. If reduced participation continues, the additional number of cancers and deaths would continue to increase. CRC screening should be continued to whatever extent it is safe. Anyone eligible for screening should participate because screening is important to preventing CRC and detecting it early.
Perspective
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The pandemic disrupted CRC screening around the world. Jonge and colleagues modelled the effect on the disruption on CRC incidence and mortality and reported that incidence of CRC would increase by 0.1% to 1.2% and CRC mortality increase would be between 0.2% to 2% by 2050.
Translated over a large population, the numbers are significant. However, the good news is that with catch-up on CRC screening efforts, the effects can be entirely mitigated but requires organized efforts.
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De Jonge L. Abstract 783. Presented at: Digestive Disease Week; May 21-24, 2021 (virtual meeting).
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