Cancer Screening, Diagnosis Rates Nearly Recover to Pre–COVID-19 Levels in the Northeastern United States

Ziad Bakouny, MD, MSc

Although cancer screening rates and ensuing diagnoses dropped significantly during the height of the COVID-19 pandemic, testing rates from June 2020 through September 2020 have nearly returned to pre-pandemic levels, according to results from a study published in JAMA Oncology.¹

During the 3-month pandemic study period, 15,452 patients had received 1 of 5 cancer screenings, including low-dose computed tomography (CT), Papanicolaou test, colonoscopy, prostate-specific antigen (PSA) screening, or mammography, leading to 1985 cancer diagnoses. Comparatively, 64,269 patients had underwent testing in the 3 months preceding the study, leading to 3423 diagnoses, and 60,344 patients were tested during the same 3 months of the preceding year of 2019, leading to 2961 diagnoses. In the 3 months following the pandemic study period, 51,944 patients were screened, which led to 3,190 diagnoses.

Additionally, while investigators noted that both testing and diagnosis rates have dropped significantly across all 5 screening tests, the percentage of positive tests appears to have been higher during the primary pandemic period vs the control periods with regard to mammographies (4.1% vs 1.9%-2.3%), PSA screenings (22.7% vs 9.9%-13.2%), colonoscopies (1.3% vs 0.7%-0.9%), and Papanicolaou tests (11.6% vs 6.5%-10.0%). However, this was not the case with regard to low-dose CT scans (0.8% vs 0.7%-0.8%).

“It’s widely thought that fewer people were screened for cancer and precancerous lesions during the first surge of the pandemic, because of limitations on non-urgent medical procedures, restrictions on patient volume, and patients’ concerns about the spread of the virus and the need for social distancing,” co-first author Ziad Bakouny, MD, MSc, a postdoctoral genitourinary oncology research fellow at Dana-Farber Cancer Institute, stated in a press release.² “For this study, we wanted to document the extent of this decline, and its impact on cancer diagnoses, at a major US health care system.”

The oncology community experienced several disruptions during the height of the COVID-19 pandemic; these challenges ranged from treatments and surgical procedures to cancer screenings. For the study, investigators set out to examine how many patients had received cancer testing and ensuing diagnoses at Massachusetts General Brigham, the largest healthcare system in the Northeastern United States, during the COVID-19 pandemic.

“This investigation is especially timely given that we are currently dealing with a second, and potentially worse, wave of the pandemic,” co-senior author Quoc-Dien Trinh, MD, an associate professor of surgery at Harvard Medical School, co-director of the Dana-Farber/Brigham and Women's Prostate Cancer Center, and director of ambulatory clinical operations in the Division of Urological Surgery at Brigham and Women’s Hospital, added in the release. “We have learned to leverage a redesigned patient flow, increased use of telehealth, and made other accommodations to allow our patients to continue receiving standard-of-care cancer screening and diagnosis in the safest possible environment.”

The study consisted of several 3-month time periods. The first peak of the pandemic in the New England area, which ranged from March 2, 2020 to June 2, 2020, was compared with the following 3 control periods: the 3 months prior to the study (December 1, 2019 to March 2, 2020), the same 3 months in the preceding year (March 2, 2019 to June 2, 2019) and 3 months after the main study period (June 3, 2020 to September 3, 2020).

Among the patients who were screened during the study (n = 192,060), the overall mean age of participants was 59.6 years. More than half, or 58.6%, of patients were female and 80.1% were non-Hispanic White.

Additional findings from the study indicated that the percentage decreases in screening were notable across all testing methods assessed compared with the 3 control periods; decreases ranged from -60% to -82%. The percentage decreases in diagnoses that resulted from the screening tests were also pronounced compared with the 3 control periods; these decreases ranged from -19% to -78%.

“Assuming the same number of patients [n = 64,269] would have otherwise been screened during the pandemic period as in the previous 3 months, approximately 1,438 cancerous and precancerous lesion diagnoses [1,985 vs 3,423 diagnoses’ were ‘missed’ during the primary pandemic period,” the authors of the study concluded.

The study was not without limitations. Investigators noted the incomplete capture of the population of Massachusetts as one limitation, along with the fact that they did not account for patients who potentially transitioned their screening procedures close to home during the pandemic to a clinician that may not have been captured in the network.

References

1. Bakouny Z, Paciotti M, Schmidt AL, et al. Cancer screening tests and cancer diagnoses during the COVID-19 pandemic. JAMA Oncol. Published online January 14, 2021. doi:10.1001/jamaoncol.2020.7600
2. Study shows sharp decline in cancer screenings and diagnoses during the first COVID-19 surge. News release. Dana-Farber Cancer Institute. January 14, 2021. Accessed March 8, 2021. http://bit.ly/3qzBFl6