Study Offers More Insight on Pandemic’s Disruption to Cancer Screening

State and local governments across the US issued shutdown orders to prevent the spread of coronavirus when the COVID-19 pandemic began in the early months of 2020. The disruptions in health care resulting from these orders are still not fully understood. However, new research led by the American Cancer Society and published in the Journal of the American Medical Association (JAMA) Network Open on June 3 offers new clarification of COVID-19’s impact on cancer screenings.

Barriers to Measuring Pandemic-Related Cancer Screening Disruption

Early reports in selected samples suggested that cancer screening decreased greatly during the first quarter of 2020, as patients heeded shutdown orders and professional society recommendations to put screening on hold. Reports based on data pertaining to commercially or Medicare insured adults noted decreases of 80 percent to 90 percent in breast, cervical, and colorectal cancer screening in March and April of 2020. While screening volumes recovered to pre-pandemic levels in the summer after cancer centers reopened and safety protocols were put in place, it was and remains unclear whether the extent of the rebound was enough to offset the earlier decreases.

One problem impairing accurate evaluation of the magnitude in disruption, the study authors note, is limited data. Previous studies measuring disruption relied on data from restricted geographical regions or were conducted among people who maintained the same health insurance coverage throughout 2020. Furthermore, the authors explain, because medical claims do not contain a patient’s long-term screening history, those studies were unable to examine both recent and guideline-concordant screening. Such an examination is helpful as short-term screening practices may be more closely linked to health care disruptions, while following longer screening intervals may be more closely associated with cancer outcomes, the authors write. Meanwhile, broader population-based estimates of cancer screening prevalence during 2020 have not yet been reported.

The Study

We are now getting a clearer picture of the magnitude of COVID-19’s disruptive impact on cancer screening, thanks to a group of researchers from the American Cancer Society. The researchers did their own survey using data from the 2014, 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System (BRFSS), an annual state-based US Centers for Disease Control and Prevention telephone interview survey with high response rates (47.0 percent, 47.0 percent, 49.9 percent, and 47.9 percent, respectively). Specifically, they looked at the prevalence of colorectal, cervical, and breast cancer screening between 2018 and 2020 to see if it changed during the pandemic:

• The analyses of breast cancer screening included a total of 479,248 people;
• The analyses of cervical cancer screening included 301,453 people in total; and
• The analyses of colorectal cancer screening included a total of 854,210 individuals.

The Study’s Findings

The researchers found that while the prevalence of screening for these three types of cancers remained steady from 2014 to 2018, past-year breast cancer screening decreased six percent and cervical cancer screening decreased 11 percent between 2018 and 2020. The biggest drops were in Hispanic people and those with lower educational attainment. On the bright side, they also found that rates of colorectal cancer screening stayed steady, with a seven percent increase in past-year stool testing offsetting a 16 percent decrease in colonoscopy between 2018 and 2020.

The study authors added that the decreases they did identify equate to about 4.47 fewer million women being screened for cervical cancer and 2.13 fewer million women being screened for breast cancer in 2020 than in 2018. They also point out that the increase in stool testing to screen for colorectal cancer during the pandemic may be attributable to the fact that stool sample collection can be done at home. The implication is that such at-home collection may be a solution for maintaining population-wide screening rates during major health care disruptions. Even so, the researchers noted that prevalence of screening for colorectal cancer remained lower for those with less education.

Takeaway

While acknowledging that their study has limitations due to biases in the data examined, the researchers suggest that decreases in screening for breast and cervical cancer among Hispanic people and those with less education may be “because of both newly emerging and existing barriers to health care,” highlighting the need to improve access to screenings for these groups. While they say that it is not yet known how these decreases in cervical and breast cancer screening will affect immediate and long-term outcomes, this impact “will be important to monitor, especially among people with lower [socioeconomic status].”