CRC screening delays due to COVID-19 most severely impact those aged at least 65 years
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Data showed that colorectal cancer screening delays of 1 to 2 years because of the COVID-19 pandemic had minimal impact on individuals aged 50 to 60 years, whereas these delays had pronounced impact on those aged 65 years and older.
Further, rescue strategies such as fecal immunochemical testing (FIT) and extended-age CRC screening could help alleviate some of these pandemic-related delays, according to the study.
“Colorectal cancer screening between ages 50 to 75 is a United States Preventive Services Task Force Grade A recommendation,” Soham Sinha, MS, a research assistant in epidemiology at Weill Cornell Medicine in New York City, and colleagues wrote in Gastroenterology. “The COVID-19 pandemic initially decreased CRC screening participation by as much as 82%, and new variants continue to disrupt preventive care.”
Sinha and colleagues assessed the impact of pandemic-related screening delays on CRC incidence and mortality in the U.S. population. They compared a 1- to 2-year delay with prompt screenings every 10 years or FIT every year through age 75 along with surveillance colonoscopy through age 80.
The three average-risk cohorts included those unscreened at age 50; unscreened at age 65, which is the age of Medicare eligibility; and screened at age 50 and due for a second screening at age 60.
The researchers also considered three different rescue strategies, including:
- FIT-based CRC screening when colonoscopy access may be limited by the pandemic;
- extended CRC screening to those aged 76 or 77, as well as CRC surveillance to those aged 81 or 82; and
- a combination of the first two strategies.
Outcomes of interest were CRC incidence and deaths per 100,000 individuals in each cohort.
In the cohort of unscreened individuals aged 50 years, the pandemic’s 1- or 2-year delay reduced both CRC incidence and CRC-related mortality by 1 absolute percentage point. Similarly, the cohort of those screened when aged 50 years experienced minimal impact on CRC incidence and CRC-related mortality due to a 1- or 2-year screening delay when aged 60 years. Rescue strategies mitigated or negated the impact in both cohorts.
However, for those unscreened and aged 65 years, a 1- or 2-year delay reduced CRC incidence and CRC-related mortality by 12 to 14 absolute percentage points, with rescue strategies aiding but not negating this impact. According to the researchers, the reduction in lifetime colonoscopy screenings from two to one affected this result.
“Our work suggests that among the 20% of the U.S. population aged 50 to 75 who are unscreened for CRC, older adults would experience the most clinical benefit from CRC screening if resources were limited during the COVID-19 pandemic,” Sinha and colleagues wrote. “Younger unscreened individuals and those awaiting CRC rescreening colonoscopy would be less affected.”
They continued, “Pandemic-related delays could be mitigated or nullified by strategies including FIT or an extended age-window for CRC screening.”
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