IMPORTANCE Public health services, including cancer screening tests, have been affected by the onset of the COVID-19 epidemic.OBJECTIVE To investigate the pandemic's association with cancer screening worldwide.DATA SOURCES In this systematic review and meta-analysis, databases such as PubMed, ProQuest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021.STUDY SELECTION Observational studies and articles that reported data from cancer registries that compared the number of screening tests performed before and during the pandemic for breast, cervical, and colorectal cancer were included.DATA EXTRACTION AND SYNTHESIS Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated between the 2 periods to assess the change in the number of cancer screening tests performed during the pandemic. Stratified analysis was performed by geographic area, period, and type of setting. The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURESThe main outcome was the weighted average percentage variation in the number of screening tests performed between January and October 2020 compared with the previous period. RESULTSThe review comprised 39 publications. There was an overall decrease of −46.7% (95% CI, −55.5% to −37.8%) for breast cancer screening, −44.9% (95% CI, −53.8% to −36.1%) for colorectal cancer screening, and −51.8% (95% CI, −64.7% to −38.9%) for cervical cancer screening during the pandemic. For all 3 cancers, a U-shaped temporal trend was identified; for colorectal cancer, a significant decrease was still apparent after May 2020 (in June to October, the decrease was −23.4% [95% CI, −44.4% to −2.4%]). Differences by geographic area and screening setting were also identified.CONCLUSIONS AND RELEVANCE A summary estimate of the downscaling of cancer screening tests since the onset of the COVID-19 pandemic is provided in this systematic review and meta-analysis. This could be associated with an increase in the number of avoidable cancer deaths. Effective interventions are required to restore the capacity of screening services to the prepandemic level.

Many health services, including cancer care, have been affected by the COVID-19 epidemic. This study aimed at providing a systematic review of the impact of the epidemic on cancer diagnostic tests and diagnosis worldwide. In our systematic review and meta-analysis, databases such as Pubmed, Proquest and Scopus were searched comprehensively for articles published between January 1st, 2020 and December 12th, 2021. Observational studies and articles that reported data from single clinics and population registries comparing the number of cancer diagnostic tests and/or diagnosis performed before and during the pandemic, were included. Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated and compared between pandemic and pre-pandemic periods. Stratified analysis was performed by geographic area, time interval and study setting. The review was registered on PROSPERO (ID: CRD42022314314). The review comprised 61 articles, whose results referred to the period January–October 2020. We found an overall decrease of − 37.3% for diagnostic tests and − 27.0% for cancer diagnosis during the pandemic. For both outcomes we identified a U-shaped temporal trend, with an almost complete recovery for the number of cancer diagnosis after May 2020. We also analyzed differences by geographic area and screening setting. We provided a summary estimate of the decrease in cancer diagnosis and diagnostic tests, during the first phase of the COVID-19 pandemic. The delay in cancer diagnosis could lead to an increase in the number of avoidable cancer deaths. Further research is needed to assess the impact of the pandemic measures on cancer treatment and mortality.

Importance: The COVID-19 pandemic has put a serious strain on health services, including cancer treatment. Objective: This study aimed to investigate the changes in cancer treatment worldwide during the first phase of the SARS-CoV-2 outbreak. Data Sources: Pubmed, Proquest, and Scopus databases were searched comprehensively for articles published between 1 January 2020 and 12 December 2021, in order to perform a systematic review and meta-analysis conducted following the PRISMA statement. Study Selection: Studies and articles that reported data on the number of or variation in cancer treatments between the pandemic and pre-pandemic periods, comprising oncological surgery, radiotherapy, and systemic therapies, were included. Data Extraction and Synthesis: Data were extracted from two pairs of independent reviewers. The weighted average of the percentage variation was calculated between the two periods to assess the change in the number of cancer treatments performed during the pandemic. Stratified analyses were performed by type of treatment, geographic area, time period, study setting, and type of cancer. Results: Among the 47 articles retained, we found an overall reduction of −18.7% (95% CI, −24.1 to −13.3) in the total number of cancer treatments administered during the COVID-19 pandemic compared to the previous periods. Surgical treatment had a larger decrease compared to medical treatment (−33.9% versus −12.6%). For all three types of treatments, we identified a U-shaped temporal trend during the entire period January-October 2020. Significant decreases were also identified for different types of cancer, in particular for skin cancer (−34.7% [95% CI, −46.8 to −22.5]) and for all geographic areas, in particular, Asia (−42.1% [95% CI, −49.6 to −34.7]). Conclusions and Relevance: The interruption, delay, and modifications to cancer treatment due to the COVID-19 pandemic are expected to alter the quality of care and patient outcomes.

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