Cancer screenings in US continued to lag during year 2 of pandemic
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Rates of past-year screening for breast, cervical and prostate cancer in 2021 remained below prepandemic levels as millions of eligible Americans continued to forgo testing, according to a study published in Journal of Clinical Oncology.
However, rates of colorectal cancer screening did not change between 2019 and the second year of the COVID-19 pandemic, as a rise in past-year stool testing offset a decrease in colonoscopy screening, researchers wrote.
Background
Previous studies showed declines in cancer screening rates during the first peak of the COVID-19 pandemic and afterward. However, because these studies relied on data from claims databases or state-based surveys, their findings could not be generalized to the U.S. population, Ahmedin Jemal, DVM, PhD, senior vice president of surveillance and health equity science at American Cancer Society, told Healio.
“In this study, we examined whether receipt of screening for breast, cervix, prostate and colorectal cancers had rebounded to the prepandemic levels during the second year of the COVID-19 pandemic based on a nationally representative database,” he said.
Methodology, results
Researchers used the 2019 and 2021 National Health Interview Survey to obtain data on U.S. Preventive Services Task Force-recommended screening for breast cancer among women aged 50 to 74 years, cervical cancer among women aged 21 to 65 years who did not undergo hysterectomy, prostate cancer among men aged 55 to 69 years, and colorectal cancer among men and women aged 50 to 75 years.
Results showed the following declines in past-year screening rates from 2019 to 2021:
The largest declines occurred among non-Hispanic Asian individuals, including a 25% decrease in breast cancer screening and a 50% decrease in prostate cancer screening.
Jemal told Healio the magnitude of the decline in the prostate cancer screening rate surprised him, noting that it compared with a 13% decrease among non-Hispanic Black men, the population with the second-largest decline.
Rates of colorectal cancer screening held steady due to an increase in past-year stool testing, from 7% to 10.3% (aPR, 1.44; 95% CI, 1.31-1.58), that offset a drop in colonoscopy, from 15.5% to 13.8% (aPR, 0.88; 95%CI, 0.83-0.95). Rates of stool testing increased 82% among Hispanic individuals, 66% among Black individuals, 52% among individuals at or below 100% of the federal poverty level, and 80% among those who resided in the Northeast.
“The increase in stool testing was pronounced in historically underserved populations,” Jemal said. “Thus, stool testing is important not only for maintaining screening levels during health care disruptions, but also for reducing racial and socioeconomic disparity in receipt of screening.”
Implications, next steps
Return-to-screening campaigns must be strengthened in order to bring cancer screening rates back to prepandemic levels, according to Jemal.
“Clinicians should play a major role for the success of such campaigns by recommending screening to each of their eligible patients according to screening guidelines,” he said. “Also, policymakers have to expand access to care to low-income populations. About 27.5 million nonelderly individuals in the U.S. were uninsured in 2022, and 11 states located in the South and Midwest have yet to expand Medicaid to low-income populations. Screening rates of uninsured adults are less than half as high as those of insured adults. For example, past-year breast cancer screening in women aged 50 to 74 years in 2022 was 29.5% in uninsured women, compared with 60.4% in privately insured women.”
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