Changes in Cancer Screening in the US During the COVID-19 Pandemic

Abstract

Key Points Question Did the national prevalence of breast, cervical, and colorectal cancer screening change during the COVID-19 pandemic? Findings In this national survey study, between 2018 and 2020, past-year breast and cervical cancer screening prevalence declined by 6% and 11%, respectively. There was no change in past-year colorectal cancer screening prevalence, with a 7% increase in stool testing and a 16% decrease in colonoscopy. Meaning These findings suggest that stool testing counterbalanced decreases in colonoscopy during 2020, whereas breast and cervical cancer screening decreased modestly.

The 2020 U.S. cancer screening deficit and the timing of adults' most recent screen: A population-based quasi-experiment

“…We also found lower proportion of adults completing their colonoscopy in the past year. However, our point estimates are smaller than the most recent population-based research (Fedewa et al 2022). We attribute this difference to the fact that our study includes adults exposed, not just to the entire pandemic year, but to the “rebound period”.…”

“…However, our understanding of this deficit is limited to hospital and claims based data, which is not necessarily a valid representation of the population’s screening behavior. Moreover, the limited population-based research has attempted to quantify changing patterns in cancer screening by comparing rates in 2020 with 2019, or an average of prior years, essentially assuming that any change observed in 2020 was due to the pandemic (Fedewa et al 2022; Dennis, Hsu, and Arrington 2021; Richardson 2022). This assumption, however, may not be valid as several factors could impact temporal screening patterns (Semprini 2022).…”

“…This assumption, however, may not be valid as several factors could impact temporal screening patterns (Semprini 2022). Finally, few studies have attempted to infer the significance of this decline or deficit in cancer screenings in terms of how the time since the most recent cancer screen may have changed (Fedewa et al 2022). This is critical for “return to screening” initiatives, as targeting or prioritizing health system capacity should consider the pandemic’s effect on the timing of a cancer screen; not just for adults who delayed care for a year, but for adults who delayed for longer or even delayed initiating their first cancer screen.…”

Rates of Routine Cancer Screening and Diagnosis Before vs After the COVID-19 Pandemic

“…1,2 Thus, many forms of health care use, including cancer screenings, sharply decreased in early 2020. [3][4][5][6] Although the temporary pause in preventive screening was clinically reasonable and situationally appropriate, long-term delays or avoidance will have adverse implications for population-level cancer-related morbidity and mortality. Studies suggest that cancer screening rebounded through summer 2020; however, more than 2 years after the start of the pandemic, long-term consequences for preventive cancer screening and diagnosis are unknown.…”

The Potential Impact of a Public Health Approach to Improving the Physical Health of People Living with Mental Illness

“…There are already disparities in cancer screening for people living with mental illness [ 23 , 24 ]. The onset of COVID-19 has been associated with fewer GP visits, a decrease in cancer screening [ 25 ], and cessations of breast screening services [ 26 ]. (The greatest increase in relative risk of early death for women living with mental illness is breast cancer).…”