The impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention

Abstract

Purpose The COVID-19 pandemic resulted in a partial to total shutdown of endoscopy in many healthcare centers. This study aims to quantify the impact of the reduction in colonoscopies on colorectal cancer (CRC) detection and screening . Methods After institutional ethics board approval, the endoscopy database at an academic tertiary-care center in Montreal, Canada, was searched for all colonoscopies performed from during the first wave locally (March–June 2020), and during the ramp up period where endoscopy service resumed (July to August 2020). We compared these periods to the same periods in 2019, the pre-pandemic periods. The indications, CRC and adenoma detection rates, as well as the prioritization of urgent procedures were compared. Results In the first wave, only 462 colonoscopies were performed, compared to 2515 in the same period in 2019, an 82% reduction. The ramp up period saw 843 colonoscopies performed compared to 1328 in 2019, a 35% reduction. Urgent and inpatient colonoscopies numbers increased (324 (24.8%) vs. 220 (5.7%)) while surveillance and high-risk screening colonoscopies fell (376 (28.8%) vs 1869 (48.6%)). Emergency access to colonoscopy was preserved with a median time to endoscopy of < 1 day (IQR 0,1) in both pandemic periods. During the pandemic periods, there was an absolute reduction in CRC diagnosis of 28, despite the CRC detection per colonoscopy rate increasing slightly in the first wave from 1.7% (44) to 3.9% (18), and in the ramp up period from 2.5% (33) to 3.6% (31). The rate of adenoma detection per colonoscopy did not increase significantly between the pre- and pandemic periods, resulting in reduction in adenoma removal in 723 patients. Discussion The restriction of access to colonoscopy resulted in a significant reduction in screening and surveillance of high-risk patients, adenomas removed, and CRCs diagnosed. Clinicians and patients will face the oncologic ramifications this the coming years. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09211-z.

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

“… 2 Moreover, the decreased number of cancer screening programs observed in many countries has contributed to the increased risk of a late diagnosis of colorectal cancer. 3 , 4 , 5 , 6 In Italy, a decrease of more than 30% in colorectal cancer screening was observed between March 2020 and May 2021. 7 In the US, a decrease in colonoscopies during 2020 was observed, especially among the population with a lower socioeconomic status.…”

Evaluation of state and trait anxiety levels in patients waiting for endoscopic procedure during the COVID-19 period

“…During the COVID-19 period, there were significant decreases in the number of endoscopic procedures, and most of the reductions were in patients who needed screening. The study by Holland et al determined that the number of procedures performed in the same period before COVID-19 decreased by 82%, colorectal cancer (CRC) screenings decreased by 48%, and those diagnosed with CRC decreased by 28% (6). In another study, a 65.7% decrease in the number of colonoscopies to be performed, a 44.6% decrease in the number of colonoscopies performed for the purpose of CRC screening, while a 2-9% increase in the number of emergency endoscopies was observed (7).…”

Colonoscopy Following an Abnormal Fecal Test Result from an Annual Colorectal Cancer Screening Program in a Federally Qualified Health Center

“…12 This interruption in the continuum of care among FQHC patients is particularly alarming given that access to GI visits has been restricted because of the COVID-19 pandemic. [41][42][43][44][45][46] Community clinics report a 5% point decrease-from 45% in 2019 to 40% in 2020-in CRC screening rates. 41 The pandemic-related backlog, combined with recent changes to US Preventive Services Task Force guidelines recommending initiation of screening at age 45 rather than age 50 (impacting roughly 20 million adults aged 45-49), has increased demand for screening and follow-up services at a time when community clinics are struggling with colonoscopy backlog for those aged 50 and older.…”