Study reveals sharp decline in early-stage cancer diagnoses in first year of pandemic
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Key takeaways:
- Cancer diagnoses among adults dropped by half in April 2020, with the greatest increase for stage I cancers.
- Monthly diagnoses of all-stage cancers returned to pre-pandemic levels by the end of 2020.
The rate of new cancer diagnoses among adults declined sharply in the early days of the COVID-19 pandemic, according to study results published in The Lancet Oncology.
Cancer diagnoses fell by half in April 2020, findings showed. Researchers observed the largest decline among stage I cancers, leading to a larger proportion of late-stage diagnoses.
“The underdiagnoses and changes in stage distribution occurred for not only cancer types detectable by screening services — eg, breast cancer, colorectal cancer, cervical cancer [and] lung cancer — but for nearly all cancers,” Xuesong Han, PhD, scientific director of health services research at American Cancer Society, told Healio.
“For example, the pattern was also quite prominent for cancers of the prostate, kidney, esophagus, stomach and liver, as well as melanoma,” Han said. “Therefore, besides return-to-screening campaigns, continued efforts are also needed to promote a return to primary care, smooth referrals from primary care to specialists, and facilitate coordination between different providers for timely detection of cancers without a screening service available.”
Background and methodology
The COVID-19 pandemic caused considerable disruption to health care. Prior studies showed sharp decreases in cancer screening utilization during the pandemic, prompting concerns that fewer malignancies would be diagnosed at earlier stages when they are more treatable.
Han and colleagues performed a cross-sectional study to assess changes in adult cancer diagnoses and stage distribution in the United States during the first year of the pandemic.
Researchers used the National Cancer Database to identify 2.74 million adults (mean age, 63.5 years; 53.5% women; 75.5% non-Hispanic white) newly diagnosed with first primary cancer in 2018 (n = 830,528), 2019 (n = 849,290) or 2020 (n = 724,232). They analyzed diagnosis trends by cancer type, as well as key sociodemographic factors.
Key findings
Total diagnoses for all stages decreased substantially after the start of the pandemic.
Researchers observed lower likelihood of stage I diagnosis (adjusted OR [aOR] for stage I vs. stage II-IV = 0.94; 95% CI, 0.93-0.95) in 2020 vs. 2019. In contrast, the likelihood of stage IV diagnosis appeared higher in 2020 than 2019 (aOR for stage IV vs. stage I-III = 1.07; 95% CI, 1.06-1.08).
This pattern remained consistent for most cancer types and sociodemographic groups. However, it appeared most pronounced among Hispanic individuals (aOR for stage 1 = 0.92; 95% CI, 0.89-0.94; aOR for stage IV = 1.11; 95% CI, 1.07-1.14), Asian American and Pacific Islander individuals (aOR for stage I = 0.92; 95% CI, 0.89-0.95; aOR for stage IV = 1.09; 95% CI, 1.05-1.14), uninsured individuals (aOR for stage I = 0.91; 95% CI, 0.87-0.96; aOR for stage IV = 1.1; 95% CI, 1.05-1.15), adults aged younger than 65 years with Medicare (aOR for stage I = 0.9; 95% CI, 0.88-0.93; aOR for stage IV = 1.1; 95% CI, 1.06-1.14), and individuals who lived in areas deemed to be the most socioeconomically deprived (aOR for stage I = 0.93; 95% CI, 0.91-0.94; aOR for stage IV = 1.1; 95% CI, 1.08-1.12).
Monthly diagnosis counts appeared to return to pre-pandemic levels by the end of 2020.
Next steps
Continued monitoring of patients diagnosed during the first year of the pandemic will be crucial to understand the true impact of the COVID-19 pandemic had on cancer diagnosis, treatment, outcomes and costs in the United States, Han said.
“Moreover, increased efforts to mitigate the disparities in these outcomes are required,” Han told Healio. “For example, re-engaging the Hispanic and Asian and Pacific Islander communities to return to screening and primary care, continuing efforts to increase insurance coverage and access to care at federal and state policy levels, and addressing health-related social needs — eg, food insecurity, housing instability [and] transportation barriers to care — for those living in socioeconomically deprived areas.”
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