Many Americans Put Off Cancer Screenings Because of COVID-19

By Linda Carroll

April 30, 2021

(Reuters Health) - Nearly 10 million screenings for three common cancers were missed in the U.S. because of the COVID-19 pandemic, a new study suggests.

A comparison of monthly screening rates during the spring and summer of 2020 to rates during 2018 and 2019 revealed a 90.8% decline in breast cancer screening, a 79.3% decline in colorectal cancer screening and a 63.4% decline in prostate cancer screening just in the month of April 2020, according to the report published in JAMA Oncology.

Screening rates for breast and prostate cancers had recovered almost completely by July of 2020, but remained reduced by about 13% for colorectal cancers, the study found.

"We found there was a deficit of 9.4 million in screening for the three major cancers across the U.S. that was most likely related to the COVID-19 pandemic," said the study's lead author, Dr. Ronald Chen, the Joe and Jean Brandmeyer Endowed Professor and chair of the department of radiation oncology at the University of Kansas Cancer Center in Kansas City. "This is a deficit we have to make up for in 2021," he added.

"There needs to be an educational campaign to make sure patients understand the importance of screening," Dr. Chen said. "If we don't do the screenings, cancers will be discovered at a later stage and we will have higher cancer deaths."

One bit of good news from the study: telehealth visits seemed to be associated with getting cancer screenings back on track. "Those who were able to access patients through telehealth were able to come up with a plan for screening," Dr. Chen said. "This emphasizes the importance of telehealth and the importance of continuing it after the pandemic is over."

To look at the impact of the pandemic on cancer screening rates, Dr. Chen and his colleagues analyzed data from the HealthCore Integrated Research Database, which contains single-payer administrative claims and enrollment information on approximately 60 million patients enrolled in Medicare Advantage and commercial health plans from across geographically diverse regions of the U.S.

For each the three years, the researchers evaluated monthly cancer screening rates from January to July. While monthly screening rates for breast, prostate and colorectal cancer were similar in 2018 and 2019, they dropped sharply in March through May of 2020 compared to the prior years.

The steepest declines in screenings for all three cancers during that period were seen in the U.S. Northeast, while the West had a slower recovery compared with the Midwest and South, patterns that were in keeping with differential rates of COVID-19 across the U.S. during the study period, the authors note.

When the researchers looked at screening declines by socioeconomic status (SES), the greatest declines were seen among people in the highest SES quartile, which had the effect of reducing disparities in screening, the study also found.

Despite the overall recovery in monthly screening rates, a deficit remained in total screenings from January through July of 2020 compared with the same time period in 2019, including missed screenings of 3.9 million women for breast cancer, 3.8 million men and women for colorectal cancer, and 1.6 million men for prostate cancer.

"This is a very interesting study," said Dr. Nicholas Rohs, an assistant professor of medicine, hematology and medical oncology at the Icahn School of Medicine at Mount Sinai. "I don't think anybody would be particularly surprised by this data, but I think it's important to analyze some of the things we didn't have bandwidth to look at when the pandemic hit. In New York, we had to face the acute issue in front of us and now we're back with a more normal flow and infection rates at least plateauing if not declining."

Physicians are just now "looking at all the 'collateral' damage from the pandemic and, in the world of oncology, one of the biggest casualties has been the lack of preventive medicine we were able to provide for our patients," Dr. Rohs said. "We will be paying the cost going forward. Anecdotally, we're seeing a lot more late presentations of disease and advanced disease. There are heartbreaking stories of patients who knew something was on their scan a year ago but were too scared to come in to pursue care during the pandemic."

SOURCE: https://bit.ly/3e3yTS7 JAMA Oncology, online April 29, 2021.

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