Short-term impact of the COVID-19 pandemic on a population-based screening program for colorectal cancer in Catalonia (Spain)

Abstract

The COVID-19 pandemic caused the suspension at all levels of the Catalan FIT-based CRC screening program on March 12, 2020. Screening invitations to FIT were resumed on September 1, 2020. We aimed to assess the short-term impact of the pandemic and describe strategies implemented to minimize harm by the disruption of the FIT-based CRC screening in the Metropolitan Area of Barcelona. We analyzed participation rate, colonoscopy adherence, time intervals to colonoscopy, detection rates, and advanced-stage cancers in 2019 and 2020. To identify perceived distress levels during the suspension of the screening we conducted a phone interview. As a result of the suspension, 43% of the individuals due for screening did not receive their invitation by December 31, 2020. A percent decrease of 5.1% in participation and of 8.9% in colonoscopy adherence among invitees between January–March was observed, with a recovery to 2019 levels when the screening activities were restarted. The time interval between a positive test to colonoscopy was longer in 2020 than in 2019. A decrease in advanced neoplasia rate and an increase in later stages of CRC were also observed. Individuals with a positive test did not report higher levels of perceived distress compared to those with a negative test. Although the disruption of screening had a temporary impact on participation and colonoscopy adherence, timing delay continues and a large backlog in the invitation of the target population remains. Thus, it is critical to implement strategies to minimize the long-term effects.

Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery

“…Invitations to the fecal immunochemical test (FIT) based colorectal cancer screening program resumed in September 2020, but ∼43% of the target population had not yet received their invitation by December 2020. Given that before the pandemic ∼11% of invasive colorectal cancers in Catalonia were detected by screening (unpublished data), the lower rates of participation, adherence to colonoscopy, and cancer detection due to the increased FIT positivity threshold during the pandemic 68 could explain why colorectal cancer diagnoses did not return to baseline levels until 6 months after reopening the screening program. The progressive increase in endoscopies and elective surgeries as the pandemic progressed probably helped the rebound in diagnosis of this cancer in all age groups, not only in the target age group of the colorectal cancer screening.…”

Self-Reported and Objective Impact of the COVID-19 Pandemic on Planning, Compliance and Timeliness of a Diagnostic Colonoscopy after a Positive FIT Screening Result in the Flemish Colorectal Cancer Screening Program

“…A decrease in DC compliance was also observed in other CRC screening programs [16][17][18]. Corely et al (2017) demonstrated that a DC after 10 months was associated with a higher CRC risk and more advanced-stage CRC compared to a DC at 8-30 days [4].…”

The impact of the Covid-19 pandemic on Italian population-based cancer screening activities and test coverage: results from national cross-sectional repeated surveys

“…33, 34 In some studies, a shift to more advanced stages and different initial therapeutic approaches have been observed for breast cancer and colorectal cancers. 35 36 37 38 39 Investigating the impact on cancer stage is out of the scope of this study. Nevertheless, computing the expected delay cumulated up to now can give an estimate of the impact on mortality and, for cervical and colorectal cancer, on incidence.…”