Impact of COVID-19 pandemic on breast and cervical cancer screening in Denmark: A register-based study

Nonboe, Mette Hartmann; Napolitano, George; Schroll, Jeppe Bennekou; Vejborg, Ilse; Waldstrøm, Marianne; Lynge, Elsebeth

doi:10.7554/elife.81605

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…We did not see any delayed pandemic effect on mortality from pancreatic cancer, which may have manifested in 2020 given the very low survival rate of this cancer (Lemanska et al, 2023), but we cannot rule out longer-term effects on breast or colorectal cancers that would not be seen until 2021 or later (Doan et al, 2023;Han et al, 2023;Haribhai et al, 2023;R. Lee et al, 2023;Nascimento de Lima et al, 2023;Nickson et al, 2023;Nonboe et al, 2023;Tope et al, 2023). Additional years of data will be important to evaluate such effects.…”

Section: Discussionmentioning

confidence: 79%

“…We did not see any delayed pandemic effect on mortality from pancreatic cancer, which may have manifested in 2020 given the very low survival rate of this cancer (Lemanska et al, 2023), but we cannot rule out longer-term effects on breast or colorectal cancers that would not be seen until 2021 or later (Doan et al, 2023;Han et al, 2023;Haribhai et al, 2023;R. Lee et al, 2023;Nascimento de Lima et al, 2023;Nickson et al, 2023;Nonboe et al, 2023;Tope et al, 2023). Interestingly, in the US, all-cause underlying cancer mortality rates do not appear to rise between 2020 and 2023 (Appendix 1 -Figure 10), but data prior to the pandemic show a rise in cancer incidence, largely driven by increasing cancer rates in younger adults (Zhao et al 2023;Siegel et al 2024).…”

Section: Discussionmentioning

confidence: 81%

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Disentangling the relationship between cancer mortality and COVID-19 in the US

Hansen,

Viboud,

Simonsen

2024

Preprint

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Several countries have reported that deaths with a primary code of cancer did not rise during COVID-19 pandemic waves compared to baseline pre-pandemic levels. This is in apparent conflict with findings from cohort studies where cancer has been identified as a risk factor for COVID-19 mortality. Here we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US by testing the impact of death certificate coding changes during the pandemic and leveraging heterogeneity in pandemic intensity across US states. We computed excess mortality from weekly deaths during 2014-2020 nationally and for three states with distinct COVID-19 wave timing (NY, TX, and CA). We compared pandemic-related mortality patterns from underlying and multiple causes (MC) death data for six types of cancer and high-risk chronic conditions such as diabetes and Alzheimer’s. Any coding change should be captured in MC data.Nationally in 2020, we found only modest excess MC cancer mortality (∼12,000 deaths), representing a 2% elevation over baseline. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematologic, 2-5%) than cancers with a poor 5-year survival (lung and pancreatic, 0-1%). In comparison, there was substantial elevation in MC deaths from diabetes (39%) and Alzheimer’s (31%). Homing in on the intense spring 2020 COVID-19 wave in NY, mortality elevation was 2-15% for cancer and 126% and 55% for diabetes and Alzheimer’s, respectively. Simulations based on a demographic model indicate that differences in life expectancy for these conditions, along with the age and size of the at-risk populations, largely explain the observed differences in excess mortality during the COVID-19 pandemic.In conclusion, we found limited elevation in cancer mortality during COVID-19 waves, even after considering coding changes. Our demographic model predicted low expected excess mortality in populations living with certain types of cancer, even if cancer is a risk factor for COVID-19 fatality risk, due to competing mortality risk. We also find a moderate increase in excess mortality from blood cancers, aligned with other types of observational studies. While our study concentrates on the immediate consequences of the COVID-19 pandemic on cancer mortality, further research should consider the pandemic impact on hospitalizations, delayed diagnosis/treatment and risk of Long COVID in cancer patients.

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Section: Discussionmentioning

confidence: 79%

“…We did not see any delayed pandemic effect on mortality from pancreatic cancer, which may have manifested in 2020 given the very low survival rate of this cancer (Lemanska et al, 2023), but we cannot rule out longer-term effects on breast or colorectal cancers that would not be seen until 2021 or later (Doan et al, 2023;Han et al, 2023;Haribhai et al, 2023;R. Lee et al, 2023;Nascimento de Lima et al, 2023;Nickson et al, 2023;Nonboe et al, 2023;Tope et al, 2023). Interestingly, in the US, all-cause underlying cancer mortality rates do not appear to rise between 2020 and 2023 (Appendix 1 -Figure 10), but data prior to the pandemic show a rise in cancer incidence, largely driven by increasing cancer rates in younger adults (Zhao et al 2023;Siegel et al 2024).…”

Section: Discussionmentioning

confidence: 81%

Disentangling the relationship between cancer mortality and COVID-19 in the US

Hansen,

Viboud,

Simonsen

2024

Preprint

View full text Add to dashboard Cite

show abstract

“…We did not see any delayed pandemic effect on mortality from pancreatic cancer, which may have manifested in 2020 given the very low survival rate of this cancer (Lemanska et al, 2023 ), but we cannot rule out longer-term effects on breast or colorectal cancers that would not be seen until 2021 or later (Doan et al, 2023 ;Han et al, 2023 ;Haribhai et al, 2023 ;R. Lee et al, 2023 ;Nascimento de Lima et al, 2023 ;Nickson et al, 2023 ;Nonboe et al, 2023 ;Tope et al, 2023 ). Additional years of data will be important to evaluate such effects.…”

Section: Discussionmentioning

confidence: 83%

Disentangling the relationship between cancer mortality and COVID-19 in the US

Hansen,

Viboud,

Simonsen

2024

eLife

View full text Add to dashboard Cite

Several countries have reported that deaths with a primary code of cancer did not rise during COVID-19 pandemic waves compared to baseline pre-pandemic levels. This is in apparent conflict with findings from cohort studies where cancer has been identified as a risk factor for COVID-19 mortality. Here we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US by testing the impact of death certificate coding changes during the pandemic and leveraging heterogeneity in pandemic intensity across US states. We computed excess mortality from weekly deaths during 2014-2020 nationally and for three states with distinct COVID-19 wave timing (NY, TX, and CA). We compared pandemic-related mortality patterns from underlying and multiple causes (MC) death data for six types of cancer and high-risk chronic conditions such as diabetes and Alzheimer’s. Any coding change should be captured in MC data. Nationally in 2020, we found only modest excess MC cancer mortality (∼12,000 deaths), representing a 2% elevation over baseline. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematologic, 2-5%) than cancers with a poor 5-year survival (lung and pancreatic, 0-1%). In comparison, there was substantial elevation in MC deaths from diabetes (39%) and Alzheimer’s (31%). Homing in on the intense spring 2020 COVID-19 wave in NY, mortality elevation was 2-15% for cancer and 126% and 55% for diabetes and Alzheimer’s, respectively. Simulations based on a demographic model indicate that differences in life expectancy for these conditions, along with the age and size of the at-risk populations, largely explain the observed differences in excess mortality during the COVID-19 pandemic. In conclusion, we found limited elevation in cancer mortality during COVID-19 waves, even after considering coding changes. Our demographic model predicted low expected excess mortality in populations living with certain types of cancer, even if cancer is a risk factor for COVID-19 fatality risk, due to competing mortality risk. We also find a moderate increase in excess mortality from blood cancers, aligned with other types of observational studies. While our study concentrates on the immediate consequences of the COVID-19 pandemic on cancer mortality, further research should consider the pandemic impact on hospitalizations, delayed diagnosis/treatment and risk of Long COVID in cancer patients.

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“…which caused a drastic decline in cervical cancer population screening in most countries around the world. The reduction of developed countries was about 40%, 32–34 whereas in developing countries, it was over 60% 32,33 . However, this reduction was predominantly oberserved at the early stage of the pandemic, and it gradually recovered up as the epidemic continued 35,36 .…”

Section: Discussionmentioning

confidence: 97%

The impact of the COVID‐19 pandemic on the prevalence and genotype distribution of HPV infection in Beijing, China

Yi,

Li,

Zhang

et al. 2023

Journal of Medical Virology

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Human papillomavirus (HPV) is one of the most common sexually transmitted infections nationwide. The COVID‐19 pandemic has greatly influenced on the HPV prevention project. The objective of this study was to examine the influence of the pandemic on HPV prevalence and genotype distribution in Beijing, China. A total of 44 401 genital swabs were obtained from outpatients at Peking Union Medical College Hospital during two distinct periods: the prepandemic stage from January 2017 to December 2019 and the pandemic stage from January 2020 to December 2022. During the prepandemic and pandemic stages, a total of 33 531 and 10 870 swabs were respectively collected. Fifteen high‐risk HPV (HR‐HPV) DNA type and a combination of two low‐risk (LR‐HPV) types (6/11) of genital swabs were detected to compare the HPV infection rates and genotype distributions in two stages. The results showed that the pandemic period witnessed a decrease in the overall HPV infection rate from 33.43% (11 245/33 531) to 29.43% (5527/18 780) compared to the prepandemic. There were statistically significant differences in infection rates between females and males (p < 0.05). Single infection was the predominant type while multiple infection was more prevalent in males than females in both prepandemic and pandemic periods. HR‐HPV infection constituted the majority of infections and cannot be disregarded. The distribution of HR‐HPV genotypes exhibited little variation before and after the outbreak, but there were some differences between females and males. HPV 16, 52, 58, 56, and 66 were the most commonly detected genotypes in females, whereas HPV 16, 52, 51, 58, and 18 were frequently detected in males. Additionally, HPV 6/11 exhibited a higher prevalence in males than in females. Notably, the age group of 31−40 years old exhibited the highest prevalence of HPV and the lowest infection rate was detected among individuals aged ≤20 years (p < 0.05), which remained relatively consistent before and during the pandemic. These findings underscore the importance of monitoring the trend of HPV epidemic and offer valuable insights for the prevention, treatment, and scientific investigation of HPV in the post‐COVID‐19 era.

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Impact of COVID-19 pandemic on breast and cervical cancer screening in Denmark: A register-based study

Cited by 9 publications

References 16 publications

Disentangling the relationship between cancer mortality and COVID-19 in the US

Disentangling the relationship between cancer mortality and COVID-19 in the US

Disentangling the relationship between cancer mortality and COVID-19 in the US

The impact of the COVID‐19 pandemic on the prevalence and genotype distribution of HPV infection in Beijing, China

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