COVID-19 caused ‘substantial deficit’ of cancer diagnoses in first 10 months of pandemic
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Key takeaways:
- Cancer diagnoses fell substantially short of expectations during the first 10 months of the COVID-19 pandemic.
- Numbers improved in the second half of 2020, but still fell below estimates.
More than 130,000 cancer cases went undiagnosed during the first 10 months of the COVID-19 pandemic, researchers estimated in a cross-sectional analysis published in JAMA Oncology.
Cancer cases fell drastically below estimates between March and May 2020, and although they rose closer to expectations in the second half of the year, they still fell short of projections based on recent trends.
“These findings identify a substantial deficit of diagnosed cancer cases in the U.S. during the COVID-19 pandemic in 2020, which underscores the need to reengage individuals in recommended cancer screenings and routine health care visits,” Todd Burus, MS, MAS, data visualization specialist at University of Kentucky’s Markey Cancer Center, and colleagues wrote.
Background and methodology
Healio previously reported the sharp decline in cancer diagnoses during the beginning of the pandemic.
Nevertheless, that did not mean incidence decreased. Rather, new cancers went undetected, researchers said.
“The longer cancer exists undetected, the greater the risk [for] tumor progression and the lower the chances of survival and other positive outcomes for patients,” they wrote.
To further insight on its effect, Burus and colleagues sought to quantify how the COVID-19 pandemic impacted cancer diagnoses.
They used data from the U.S. Cancer Statistics 2001-2020 Public Use Database, which includes about 99.7% of cancer cases across the United States.
Investigators calculated monthly incidence rates for all cancers diagnosed between 2018 and 2020, as well as statistics for 11 cancer types.
They also separated the first 10 months of the pandemic into two periods — March-May and June-December — to determine the difference in rates between the sudden interruption of life and the extended stay-at-home orders.
Results, next steps
Researchers included 1,297,874 cancer cases from March 1, 2020, through the end of that year. The majority occurred in men (50.7%), individuals aged 65 years and older (58.3%) and white patients (82.2%).
Expected cases fell by 28.6% in the first 3 months of the pandemic. Numbers increased in the last half of 2020, but they still fell 6.3% below the predicted amount.
The analysis estimated 13% of cancer cases went undiagnosed overall, amounting to 134,395 incidents —“approximately one missed case per nine cases diagnosed,” Burus and colleagues wrote.
All cancer types evaluated had statistically significant disruptions from March to May, and only female breast and pancreatic cancers did not from June to December.
Prostate cancer had the most estimated undiagnosed cases (22,950) followed by female breast cancer (16,870) and lung cancer (16,333).
Screenable cancer diagnoses — defined as female breast, lung and bronchus, colon and rectum, and cervix uteri — fell 13.9% short of estimates. Likewise, early-stage diagnoses fell 15.8% below estimates, and late-stage incidence fell 11.5% lower than expected.
“With a near 10% reduction from expected rates in overall late-stage incidence from March to December 2020, there will undoubtedly — and unfortunately — be a subsequent rise in cancer mortality,” researchers wrote. “How substantial a rise and for how long will provide a more complete picture of the consequences of COVID-19 disruptions on the burden of cancer in the U.S.”
Lower diagnoses for all cancers occurred in states with more restrictive public health policies in response to COVID-19.
Study limitations included potential delays in cancer reporting, as well as not accounting for demographic variables, thus preventing deeper analysis.
“The findings from this analysis can inform the U.S. health care system as decisions are made to recover the deficit through focused cancer screening and detection,” researchers wrote. “These findings may also assist with planning for any future disruptions that would otherwise affect the timeliness of cancer diagnosis.”
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