Cancer Screening Recommendations During the COVID-19 Pandemic: Scoping Review

Abstract

Background Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the use of preventive health care services. Although there was an increase in the number of cancer screening tests beginning in late 2020, screenings remained 29% to 36% lower than in the prepandemic era. Objective The aim of this review is to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. Methods We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. The literature review ranged from January 1, 2020, to September 30, 2021. Results The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, patients in certain age groups and sex, patients with a personal medical or family cancer history, patients that are currently symptomatic, and patients that are predisposed to hereditary cancers and cancer-causing mutations. Other recommended strategies included identifying areas facing the most disparities, creating algorithms and using artificial intelligence to create cancer risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods that do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers, and implementing or expanding mobile screening units. Conclusions Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and underresourced areas after the pandemic has ended.

Impact of the COVID‐19 pandemic on the hospital attendance of patients with primary cervical cancer in Heilongjiang, China

“…32 Studies have predicted that delays in cancer diagnosis and treatment due to the COVID-19 pandemic may affect clinical outcomes over the next decade 33 and have suggested that long-term preventive measures to protect patients from COVID-19 may increase cancer-related mortality. [34][35][36] Therefore, a series of measures should be taken to ensure cancer screening in public health emergencies, 26,37 such as allocating a sufficient number of healthcare workers; using risk stratification and classification to prioritize screening high-risk women; using alternative cancer screening methods such as self-sampling postal testing or establishing rapid diagnostic kits; after a short training period, allowing staff such as general practitioners, midwives or nurses to participate in screening programs. However, the specific effects of the above methods need to be confirmed by further studies.…”

Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic

“…Mailed FIT outreach programs have been shown to increase CRC screening rates and to be cost-effective [ 38 – 41 ], but were not widely adopted in primary care clinics prior to the COVID-19 pandemic [ 42 ]. This public health emergency served as a catalyst for primary care clinics to adopt mailed FIT outreach as a means to continue promoting CRC screening while addressing patient hesitancy to attend in-person appointments, reducing patient risk for COVID-19 exposure and addressing the issue of postponed or missed non-urgent procedures (including screening colonoscopies) during periods of high infection rates [ 10 , 15 , 16 , 43 ]. Consistent with previous studies [ 42 ], we found that mailed FIT outreach is challenging without adequate staff capacity and systems for tracking FIT kit dissemination and return and follow-up to ensure patients with positive test results complete a timely colonoscopy.…”

Reaching the “Hard-to-Reach” Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management

“…Additionally, results gathered by this study illustrate the impact that COVID-19 has had on the healthcare field and the accessibility of services for all populations ( 75 )., showing decreased access to care over the previous 12 months. This impact was more pronounced among populations that experience inequities due to their rural residence, since a common solution for access to care during the pandemic was telehealth, which, further exacerbated the digital divide in these communities and a considerable drop in cancer screening ( 36 , 76 ).…”