Data confirm decline in cancer screenings, diagnoses amid first peak of COVID-19 pandemic
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Substantial decreases in cancer screenings and diagnoses occurred during the first peak of the COVID-19 pandemic across one large U.S. health care system, according to a research letter published in JAMA Oncology.
“The COVID-19 pandemic has disrupted routine and elective health care services across the country. This study aimed to investigate one particular effect of the pandemic — the disruption in cancer screening and the resulting effect on cancer diagnoses,” Ziad El Bakouny, MD, MSc, researcher in the department of medical oncology at Dana-Farber Cancer Institute, told Healio. “We found that the number of cancer screening tests substantially decreased during the pandemic period and that this was accompanied by a decrease in cancer and precancer diagnoses.”
El Bakouny and colleagues calculated the number of cancer screening tests — mammography, PSA testing, colonoscopy, Pap smear and low-dose CT scans — performed within the Massachusetts General Brigham health care system and ensuing diagnoses during the first peak of the pandemic, from March 2 to June 2. They then compared the data with that of three control periods: 3 months before the first peak of the pandemic, 3 months after the first peak and the same 3 months during 2019.
Overall, 192,060 patients (mean age, 59.6 years; 58.6% women; 80.1% white) underwent cancer screening within the health care system during all four time periods.
Among them, 15,453 underwent screening during the March-to-June period, with 1,985 ensuing cancer diagnoses, compared with 64,269 screened and 3,423 diagnoses during the preceding 3 months, 51,944 screened and 3,190 diagnoses during the subsequent 3 months, and 60,344 screened and 2.961 diagnoses during the same 3-month period in 2019.
The percentage of screening tests that came back positive also appeared higher during the peak pandemic period compared with all three control periods for mammography (4.1% vs. 1.9%-2.3%), PSA screening (22.7% vs. 9.9%- 13.2%), colonoscopy (1.3% vs. 0.7%- 0.9%) and Pap test (11.6% vs. 6.5%- 10%), but not for low-dose CT scans (0.8% vs. 0.7%- 0.8%).
“The extent of decrease in the ensuing cancer diagnoses of 19% to 78% was less pronounced than the decrease in cancer screening tests of 60% to 82%. This was because a greater percentage of screening tests yielded a cancer and precancer diagnosis, likely reflecting risk-based prioritization of patients for screening,” El Bakouny said.
Overall, had there been no decrease in cancer screenings during the 3-month peak pandemic period, researchers hypothesized that 1,438 additional cancers and precancers would have been diagnosed based upon the numbers during the previous 3 months.
“Reassuringly, during the first 3 months after the first peak of the pandemic, we saw a near-complete recovery of the number of screening tests performed,” El Bakouny said. “Oncologists and health care providers in general should speak with their patients about rescheduling any missed cancer screening tests in order to avoid missing or delaying cancer diagnoses.”
For more information:
Ziad El Bakouny, MD, MSc, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: ziad_elbakouny@dfci.harvard.edu.
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