Routine Cancer Screenings Still Below Prepandemic Levels

Patricia McKnight

December 08, 2022

Cancer screenings for breast, cervical, and colorectal cancer remain below prepandemic levels, having never fully bounced back after the initial sharp declines early in the pandemic, according to findings from a recent study.

Overall, the screening prevalence rates for the three cancer types analyzed declined by 6% to 7% from 2019 to 2020 and an additional 4.8% to 6.1% from 2020 to 2021.

"The findings suggest that screening quickly rebounded after the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened," the study authors say.

The study was published last month in JAMA Oncology.

The COVID-19 pandemic caused significant disruptions in the use of healthcare in the US, including cancer screenings. Studies suggest that cancer screenings declined sharply in early 2020 and rebounded in summer 2020. However, nearly 3 years after the start of the pandemic, the long-term effects of the pandemic on preventive cancer screening remain less clear.

In the current study, researchers compared patterns of breast, cervical, and colorectal cancer screening rates before and during the pandemic.

The study team analyzed data from the Trilliant Health all-payer medical claims and encounters database, which includes inpatient, outpatient, and prescription drug claims from all 50 states and the District of Columbia. The authors gathered quarterly medical claims from 306 million patients aged 21 to 85 between January 2017 and December 2021.

For breast and cervical cancer, only women were included, while both men and women were included in the colorectal data. Researchers calculated the number of individuals per 100,000 beneficiaries who received screening for breast, cervical, and colorectal cancer each quarter.

For breast cancer, the median quarterly rate of prepandemic screening mammography was 8216 per 100,000 beneficiaries. This declined to 4951 in the second quarter of 2020 when initial lockdowns occurred — an overall 40% decrease. Mammogram screenings rebounded to prepandemic levels by the third and fourth quarters of 2020 but declined again in 2021 to a median quarterly rate of 7374 per 100 000 beneficiaries — about a 10% decline from prepandemic levels.

For cervical cancer, the median quarterly rate of prepandemic screening was 5602 per 100,000 beneficiaries. This fell to 3563 in the second quarter of 2020 — a 36% decline. By the third quarter of 2020, cervical cancer screenings began to rebound to prepandemic rates but then steadily decreased from 4853 in the fourth quarter of 2020 to 4246 by the end of 2021 — an almost 25% decline from prepandemic levels.

Colorectal cancer screening fell the most from prepandemic levels to the second quarter of 2020 — a 45% decline from a median 3162 per 100,000 beneficiaries to 1746. Screening began to bounce back through the end of 2021, with quarterly rates ranging from 2590 to 2861 per 100,000 beneficiaries, or between 82% to 90% of the prepandemic median.

"The pattern we found suggests a substantial proportion of forgone care through 2021," the study authors conclude. "To mitigate long-term consequences, multiple stakeholders will need to consider novel strategies and dedicate appropriate resources to increase guideline-concordant cancer screening."

JAMA Oncol. Published online November 17, 2022. Full text

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