Screening rates for prostate, breast and colorectal cancer in the US dropped sharply during March through May 2020 — the early months of the COVID-19 pandemic — compared with the same period in 2019, with the biggest decline occurring in April, investigators reported in JAMA Oncology.
The declines were most pronounced in the Northeast US and among individuals of high socioeconomic status (SES).
During March, April, and May 2020, the rates per 100,000 enrollees in Medicare Advantage or commercial insurance plans decreased by 27.4%, 63.4% and 35.0%, respectively, for prostate cancer; 41.8%, 90.8%, and 52.6% for breast cancer; and 33.3%, 79.3%, and 57.7% for colorectal cancer, according to Ronald C. Chen, MD, MPH, of the University of Kansas in Kansas City, and colleagues. Monthly screening rates for prostate and breast cancers recovered completely by July 2020, they noted.
The investigators estimated that the absolute deficit across the US population in screening associated with the COVID-19 pandemic was 1.6 million, 3.9 million, and 3.8 million for prostate, breast, and colorectal cancer, respectively, for a total deficit of 9.4 million screenings.
The Northeast experienced the biggest decline in screening from March through May 2020 compared with the same period in 2019, whereas the South and West regions had lower magnitudes of decline, the investigators reported. “This corresponds to the differential timing of COVID-19 rates across different regions of the country, with New York and other Northeastern states reporting early and higher surges of COVID-19 cases.”
Declines in cancer screening rates varied by SES, with the biggest declines among those in the highest quartile of SES. For example, the decline in the prostate cancer screening rate in April 2020 compared with April 2019 was 69.1% for those in the fourth quartile compared with 56.5%, 59.8%, and 61.9% for those in the first, second, and third quartiles, respectively.
Multivariate analysis that adjusted for SES showed that telemedicine use was associated with receipt of cancer screening. In March, April, and May 2020, telehealth use compared with nonuse was significantly associated with a 1.13-, 2.46-, and 1.40-fold increased likelihood of cancer screening, respectively.
“This suggests a potential benefit of telehealth: while the COVID-19 pandemic led to broad cancellations of nonemergency in-person health care appointments, telehealth appointments might have enabled individuals to still receive medical consultation and advice, as well as a plan for rescheduling screening tests,” the authors wrote.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Chen RC, Haynes K, Du S, Barron J, Katz AJ. Association of cancer screening deficit in the United States with the COVID-19 pandemic. JAMA Oncol. Published online April 29, 2021. doi:10.1001/jamaoncol.2021.0884