The COVID-19 Pandemic and Cancer Screenings

The impact of the COVID-19 pandemic will be felt for decades after it is declared “over.” India is currently being devastated by an immense surge, reporting over 4000 deaths in a single day, and over 300,000 cases reported daily. As the world works to understand the impact of the new variants, including B.1.617 (emerging in India) while wrestling with widespread vaccine inequity, COVID-19 continues to challenge response.

One of the aspects of a pandemic that we struggle with though, is understanding the true implications of preventable deaths and negative health outcomes as a result of impacted care. One of these particular health outcomes is cancer. The National Cancer Institute estimates that in 2020, there were 1.8 million new cases of cancer diagnosed within the United States, and 606,520 deaths due to cancer. The most common cancers in the United States are breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, and melanoma.

A new study published in JAMA Oncology sought to understand the impact and association of the COVID-19 pandemic with cancer screening rates across the United States. Performing a retrospective cohort study, the researchers used the HealthCore Integrated Research Database to study data for 60 million people in Medicare Advantage and several other health plans from January-July of 2018, 2019, and 2020.

The main outcomes were receipt of breast, colorectal, or prostate cancer screenings in those without a diagnosis of cancer in the prior year. Following their analysis, the research team reported that “screening for all 3 cancers declined sharply in March through May of 2020 compared with 2019, with the sharpest decline in April (breast, −90.8%; colorectal, −79.3%; prostate, −63.4%) and near complete recovery of monthly screening rates by July for breast and prostate cancers.

The absolute deficit across the US population in screening associated with the COVID-19 pandemic was estimated to be 3.9 million (breast), 3.8 million (colorectal), and 1.6 million (prostate).

Geographic differences were observed: the northeast experienced the sharpest declines in screening, while the West had a slower recovery compared with the midwest and south. For example, percentage change in breast cancer screening rate (2020 vs 2019) for the month of April ranged from −87.3% (95% CI, −87.9% to −86.7%) in the west to −94.5% (95% CI, −94.9% to −94.1%) in the northeast (decline). For the month of July, it ranged from −0.3% (95% CI, −2.1% to 1.5%) in the midwest to −10.6% (−12.6% to −8.4%) in the west (recovery).”

When evaluating the role of socioeconomic status (SES), the authors noted a significant screening decline in those individuals within the highest SES quartile. The delays in these cancer screenings are exactly the concern of so many in public health and medicine as the pandemic is suspected of leading to excessive morbidity and mortality. As this is the first study to assess screening fluctuations and geographical variances, further research is needed, but also targeted efforts to ensure such declines are remedied in 2021.

These sharp declines against common cancers within the United States in March through May 2020 are deeply worrisome and should be a prime topic of concern for public health interventions, in addition to equitable vaccine distribution and COVID-19 response. Future pandemic preparedness and response efforts should utilize these findings to ensure proactive measures are in place to avoid such sharp declines in cancer screening.