The lower rates of cancer screening associated with the coronavirus pandemic are likely to translate to increased cancer deaths over the next decade, according to new research. Published in the journal Cancer, the study demonstrated how the pandemic impacted screening rates for breast, colorectal, lung, and cervical cancers in the U.S., finding that more than 9.4 million screening exams were missed in 2020 (2022; https://doi.org/10.1002/cncr.34157).
A team led by researchers from Northwestern University and the American College of Surgeons conducted a prospective national quality improvement study on Return-to-Screening, enrolling 748 accredited cancer programs in the U.S. from April 2020 through June 2021. Local pre-pandemic and pandemic monthly screening test volumes were used to calculate the relative percent change in these volumes to describe the monthly screening gap, the authors wrote. The researchers sought to share preliminary data on monthly screening deficits in breast, colorectal, lung, and cervical cancers across diverse settings, and to provide online materials from their quality improvement study that would help other institutions address local screening deficits.
Overall, the majority of facilities reported monthly screening deficits. Colorectal cancer had the highest monthly screening deficit in 2020, with 80.6 percent of facilities showing a monthly screening deficit for colorectal cancer, representing a nearly 18 percent median relative percent change in monthly screening deficits.
Just under 70 percent of these same facilities reported a monthly screening deficit for cervical cancer, signifying a 6.8 percent change. Fifty-five percent showed a monthly screening deficit for breast cancer, with 44.6 percent demonstrating a deficit with regard to lung cancer.
The results illustrate that "cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020," the researchers concluded.
"The impetus for the study was to reverse the impact of the pandemic on cancer screening," stated Heidi Nelson, MD, FACS, Director of Cancer Programs at the American College of Surgeons. "We know that cancer screening saves lives, and we were aware that millions of people missed their screenings due to the pandemic. We also suspected that monthly screening rates had not returned to normal, even several months into the pandemic, and our study proved this assumption to be correct," added Nelson, noting that she and her colleagues were testing to determine whether accredited cancer programs could "help reverse the impact of the pandemic on screening, thereby reducing the risk that people would present with advanced, untreatable cancers."
The number of accredited Commission on Cancer and National Accreditation Programs for Breast Centers that signed up to participate in this national effort-748-just confirmed to the authors "the importance of the return to screening effort," she said. "This outpouring of interest and engagement also convinced us that our cancer programs would help reverse the downward trends in cancer screening."
Nelson attributes the lower rates of cancer screening since early 2020 to a number of factors, including limitations of medical resources and patient reluctance, noting that elective procedures were curtailed within the first few months of the coronavirus pandemic "until protective procedures could be put into place to keep patients safe from COVID-19 infections."
As the pandemic wore on, "we know that staffing resources were often diverted to meet the demands of COVID-19 infections during pandemic surges," she added. "We speculate that patients were apprehensive about elective exposure to risks of infection from medical facilities."
As far as the finding that these lower screening rates could well lead to increased cancer deaths in the coming years, Nelson reiterated the need to perform screening early.
"Cancer screening saves lives. Cancer screening is performed before patients have cancer symptoms," she said. "Cancers found at screening tend to be early and more likely to be treated for cure. Finding and treating cancers early helps reduce the burdens associated with advanced cancer, and it is an important way that we reduce unnecessary cancer deaths."
Ultimately, the most important message to emerge from these findings is the reality that monthly screening rates were "significantly compromised during the pandemic, including several months into the pandemic. Now is the time to make up for missed screenings," Nelson emphasized.
"Whether you are conducting screening tests as radiologists, gastroenterologists, primary care doctors, or you are sending people for screening, the message is the same; now is the time to get screened. And the take-home message for the public is that cancer screening saves lives. Now is the time to get cancer screening if you are due for screening or if you missed screening during the pandemic. Now is the time to reach out to your health care professional to ask about cancer screening."
Mark McGraw is a contributing writer.