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Early in the pandemic, experts warned that the steep drop in cancer screenings could have dire consequences for cancer care. Now, a new study has provided some hope about the potential for recovery of cancer screening, but the road ahead might not be easy, says an expert.
The study was conducted at the Massachusetts General Hospital Brigham, Boston, Massachusetts, the largest hospital system in the Northeast. It was published online January 14 in JAMA Oncology.
Cancer screening at this center dropped about fourfold during the first COVID-19 surge in spring 2020, but it recovered almost to prepandemic levels during the summer months.
The drop in screenings was tied to a decrease in cancer diagnoses, including missed or delayed diagnoses. The researchers estimate that about 1438 cancer diagnoses were missed during the first COVID surge from March to June 2020.
This study provides a glimmer of hope that cancer screenings can rebound quickly, says William Cance, MD, chief medical and scientific officer of the American Cancer Society (ACS), who was approached for comment.
It provides much-needed hard-core data about cancer screening and diagnoses during the pandemic, beyond earlier modeling and predictions, he said.
"The good news is that this institution was able to get back to baseline. This is one of the top healthcare systems in the world, and it's great to see their concern to make it happen," he said.
Still, the estimates of missed cancers are "very concerning," he added. Extensive delays in cancer are associated with worse outcomes, so "it's really critical that we find and reach the people who missed their screens," he told Medscape Medical News.
Recovery of cancer screenings and diagnoses in the 3 months after the first surge reflects some catch-up, but not enough. For that, screening would need to exceed the previous years' baseline. Given the current COVID surges, screening is likely to continue to be a challenge until widespread vaccination happens, he explained.
"The bottom line is there is a lot of catching up to find and treat these undiagnosed cancers," he said. "This return to screening is going to be the top priority of the ACS next year, getting people back to screening, particularly those with symptoms or family histories of cancer."
Impact of the First COVID Surge
For the study, the researchers assessed medical records data for five cancer screening tests: low-dose CT, Pap smear, colonoscopy, prostate-specific antigen (PSA) testing, and mammography.
They then compared changes in cancer screening and diagnoses for four 3-month periods:
The first surge of the pandemic in New England (March to June 2020)
The same 3-month period in 2019 (March to June 2019)
The 3 months before the pandemic hit (December 2019 to March 2020)
The 3 months after the first surge (June to Sept 2020)
Over the course of these four study periods, 192,060 patients received cancer screening. The mean age of the patients was 59.6 years. Of these patients, 58.6% were female, and 80.1% were non-Hispanic.
Results showed that during the first surge of the pandemic (March to June 2020), cancer screening fell by 60% to 82% for all five screening tests.
During that period, only 15,453 patients received screening, compared to 64,269 for the 3 months before the pandemic hit and 60,344 for the same period in 2019. On the other hand, 51,944 patients received screening in the post-surge period, suggesting recovery.
Commenting on this recovery of cancer screening service, co–senior author Quoc-Dien Trinh, MD, Brigham and Women's Hospital, said: "We have learned to leverage a redesigned patient flow, increased use of telehealth, and made other accommodations to allow our patients to continue receiving standard-of-care cancer screening and diagnosis in the safest possible environment."
During the first surge, cancer diagnoses for all five tests fell by 19% to 78%. Among patients screened during this period, 1985 received a diagnosis of cancer, compared to 3423 during the 3 months before the surge and 2961 during the same period in 2019. During the 3 months after the first surge, 3423 patients received a diagnosis of cancer.
The researchers estimate that about 1438 cancer diagnoses were missed during the first surge. This estimate is based on the assumption that the same number of patients would have been screened during the surge as were screened during the preceding 3 months.
The authors note that the number of missed diagnoses may have been lower than anticipated, because the percentage of positive screens was generally higher during the surge compared to the other three periods: mammography, 4.1% vs 1.9% – 2.3%; PSA, 22.7% vs 9.9% – 13.2%; colonoscopy, 1.3% vs 0.7% – 0.9%; and Pap smear, 11.6% to 6.5% – 10.0%. The exception was low-dose CT, which was similar (0.8% vs 0.7 – 0.8%).
The results may reflect prioritization of high-risk patients for cancer screening during the pandemic, according to the authors.
The study was supported by grants from the Defense Health Agency and the Vattikutti Urology Institute. One or more authors reports potential conflicts of interest from one or more of the following: Genentech/IMCore, Bristol-Myers Squibb, Astellas, Pfizer, the COVID-19 and Cancer Consortium, Exelixis, Merck, Roche/Genentech, Novartis, Bayer, Janssen, and/or Intuitive Surgical.
JAMA Oncol. Published online January 14, 2021. Abstract
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Cite this: Cancer Screenings Rebound After COVID Surge, but Catch-Up Needed - Medscape - Jan 21, 2021.