The impact of the temporary suspension of national cancer screening programmes due to the COVID-19 epidemic on the diagnosis of breast and colorectal cancer in the Netherlands

Abstract

Oncological care was largely derailed due to the reprioritisation of health care services to handle the initial surge of COVID-19 patients adequately. Cancer screening programmes were no exception in this reprioritisation. They were temporarily halted in the Netherlands (1) to alleviate the pressure on health care services overwhelmed by the upsurge of COVID-19 patients, (2) to reallocate staff and personal protective equipment to support critical COVID-19 care, and (3) to mitigate the spread of COVID-19. Utilising data from the Netherlands Cancer Registry on provisional cancer diagnoses between 6 January 2020 and 4 October 2020, we assessed the impact of the temporary halt of national population screening programmes on the diagnosis of breast and colorectal cancer in the Netherlands. A dynamic harmonic regression model with ARIMA error components was applied to assess the observed versus expected number of cancer diagnoses per calendar week. Fewer diagnoses of breast and colorectal cancer were objectified amid the early stages of the initial COVID-19 outbreak in the Netherlands. This effect was most pronounced among the age groups eligible for cancer screening programmes, especially in breast cancer (age group 50–74 years). Encouragingly enough, the observed number of diagnoses ultimately reached and virtually remained at the level of the expected values. This finding, which emerged earlier in age groups not invited for cancer screening programmes, comes on account of the decreased demand for critical COVID-19 care since early April 2020, which, in turn, paved the way forward to resume screening programmes and a broad range of non-critical health care services, albeit with limited operating and workforce capacity. Collectively, transient changes in health-seeking behaviour, referral practices, and cancer screening programmes amid the early stages of the initial COVID-19 epidemic in the Netherlands conjointly acted as an accelerant for fewer breast and colorectal cancer diagnoses in age groups eligible for cancer screening programmes. Forthcoming research is warranted to assess whether the decreased diagnostic scrutiny of cancer during the COVID-19 pandemic resulted in stage migration and altered clinical management, as well as poorer outcomes.

Cytopathology practice during the COVID‐19 postlockdown: An Italian experience

“…Reassuringly, the positive trend observed in period IV confirmed the role of breast FNA as a valuable component of the triple test, especially in the era of COVID-19. 18,19 A similar nonlinear trend was also reported for salivary gland FNA. Indeed, the FNA workload reduction was more evident in periods II (-89.5%) and III (-61.5%) than periods I (-30%) and IV (-47%).…”

Inequalities in the decline and recovery of pathological cancer diagnoses during the first six months of the COVID-19 pandemic: a population-based study

“…These results are in keeping with trends in the Netherlands, which showed a steep decline in breast cancer cases during the initial stages of the pandemic, with the screening age population more affected than women of non-screening age. (8) However, in the Netherlands the non-screening age group recovered more quickly to expected levels, whereas our results suggest a more rapid recovery in the screening age group.…”

“…They found a reduction in observed breast and colorectal cancer diagnoses in the population as a whole, but particularly in the screening age groups, with recovery to expected levels by late June 2020. (8) In contrast to this, a Korean study of lung cancer cases in three hospitals found that the number of lung cancer diagnoses from February to June 2020 did not differ significantly from the previous 3 years. (9) Finally, a Danish study investigating all-cause mortality rates (including cancer mortality) from 1 st January through to 5 th July 2020 found that there was no excess mortality as a result of COVID-19 or the resulting lockdown in Denmark.…”

The impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: A time-series analysis of primary care electronic health records covering about 5 million people

“…In addition, as well as in our context, some of these reductions are related to a suspension or decline in cancer screenings services, with breast cancer screenings dropping by 89.2% and colorectal cancer screenings by 84.5% in some countries [20, 24, 36]. For example, a recent research in the Netherlands described that the temporary halt of national population screening programmes led to a fewer breast and CRC in age groups eligible for cancer screening programmes [37]. However, some studies pointed out that reduction of diagnostic procedures is also related to a decrease in cancer encounters, leading to a reduction in diagnostic suspicion [20].…”