How the COVID-19 pandemic has affected the colorectal cancer screening in Italy: A minireview

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused detrimental effects on many aspects of healthcare practice. Screening programs for the commonest malignancies, namely colorectal cancer (CRC), breast cancer and cervical cancer have been discontinued or interrupted since the beginning of restriction measures aimed to limit transmission of the new coronavirus infection. Robust evidence exists in favour of the role of screening campaigns in reducing mortality from CRC. In fact, the majority of pre-malignant lesions of the colon and rectum can be diagnosed with colonoscopy and treated by endoscopic or surgical resection. Besides, colonoscopy screening allows the diagnosis of CRCs in their pre-clinical stage. Italy was one of the first European countries where a high level of COVID-19 infections and deaths was observed, and one of the first where lockdowns and strict measures were adopted to reduce the risk of COVID-19 diffusion among the population. A systematic review of the literature was performed, including the PubMed, Scopus, Web of Sciences, and Reference Citation Analysis databases, with the aim of critically evaluating the impact of the COVID-19 pandemic on CRC screening in Italy. We found that reduction of CRC screening activity surpassed 50% in most endoscopic units, with almost 600000 fewer CRC screening exams conducted in the first 5 mo of 2020 vs the same period of 2019. While the consequences of the discontinuation of endoscopy screening for the prognosis and mortality of CRC will be evident in the next few years, recent data confirm that CRC is currently treated at a more advanced stage than in the pre-COVID-19 era. Since delays in CRC prevention and early diagnosis may translate to increased CRC-specific mortality, world healthcare systems should adopt strategies to maintain the regularity of CRC screening during subsequent peaks of the COVID-19 pandemic, or future events that might hamper screening programs.

An umbrella review of systematic reviews on the impact of the COVID-19 pandemic on cancer prevention and management, and patient needs

“…Of the 51 included systematic reviews, 14 articles also included a quantitative analysis/meta-analysis with one being individual participant meta-analysis ( Dhada et al, 2021 ; Teglia et al, 2022a ; Teglia et al, 2022b ; Nikolopoulos et al, 2022 ; Zhang et al, 2022 ; Kirby et al, 2022 ; Donkor et al, 2021 ; Gascon et al, 2022 ; Hojaij et al, 2020 ; Legge et al, 2022 ; Murphy et al, 2022 ; Gadsden et al, 2022 ; Majeed et al, 2022 ; Adham et al, 2022 ; Alom et al, 2021 ; Ayubi et al, 2021 ; Garg et al, 2020 ; Jammu et al, 2021 ; Lu et al, 2021 ; Momenimovahed et al, 2021 ; Mostafaei et al, 2022 ; Moujaess et al, 2020 ; Muls et al, 2022 ; Pacheco et al, 2021 ; Rohilla et al, 2021 ; Salehi et al, 2022 ; Sun et al, 2021 ; Zapała et al, 2022 ; Alkatout et al, 2021 ; Di Cosimo et al, 2022 ; Fancellu et al, 2022 ; Ferrara et al, 2022 ; Hesary and Salehiniya, 2022 ; Lignou et al, 2022 ; Mayo et al, 2021 ; Mazidimoradi et al, 2021 ; Mazidimoradi et al, 2022 ; Ng and Hamilton, 2022 ; Pararas et al, 2022 ; Riera et al, 2021 ; Sarich et al, 2022 ; Sasidharanpillai and Ravishankar, 2022 ; Tang et al, 2022 ; Thomson et al, 2020 ; Vigliar et al, 2020 ; de Bock et al, 2022 ). Other key characteristics of the 51 systematic reviews are shown in Table 1 (more extensive details appear in Supplementary file 1a and Supplementary file 2 ).…”

“…Out of 51 reviews, 46 provided some information on geographical distribution of the included primary studies. Of those, most reviews provided data from different countries, while only two studies (3.9%) focused on data from India ( Rohilla et al, 2021 ) and Italy ( Fancellu et al, 2022 ) exclusively. Also the majority of the evidence was derived from high- and middle-income countries.…”

“…The results of 11 reviews ( Teglia et al, 2022a ; Alkatout et al, 2021 ; Fancellu et al, 2022 ; Ferrara et al, 2022 ; Hesary and Salehiniya, 2022 ; Mayo et al, 2021 ; Mazidimoradi et al, 2022 ; Ng and Hamilton, 2022 ; Sasidharanpillai and Ravishankar, 2022 ; Vigliar et al, 2020 ; Bougioukas et al, 2018 ) reporting on cancer screening are summarized in Supplementary file 1e and Table 4 . Of these, five included a meta-analysis.…”

“…Main findings of the 11 reviews ( Nikolopoulos et al, 2022 ; Majeed et al, 2022 ; Alkatout et al, 2021 ; Fancellu et al, 2022 ; Ferrara et al, 2022 ; Hesary and Salehiniya, 2022 ; Lignou et al, 2022 ; Mazidimoradi et al, 2021 ; Ng and Hamilton, 2022 ; Vigliar et al, 2020 ; Pascual et al, 2022 ) providing data on reduction in cancer diagnosis are provided in Supplementary file 1f and Table 4 . Reviews were consistent in reporting decreased diagnosis of new cancer cases during the pandemic, although the reduction depended on the geographical area, the period being investigated and type of cancer.…”

Changes in cancer prevention and management and patient needs during the COVID-19 pandemic: An umbrella review of systematic reviews

“…The median number of studies included in the systematic reviews was 31 (interquartile range, 15.5; 49). Most reviews provided data from different countries, while only two studies focused on data from India 29 and Italy 35 exclusively. The type of study designs included across reviews varied, but most reviews included data from observational study designs of cross-sectional and retrospective nature.…”