Impact of the COVID-19 Pandemic on Lung Cancer Screening Program and Subsequent Lung Cancer

Abstract

Background Low-dose CT (LDCT) screening reduces lung cancer mortality by at least 20%. The COVID-19 pandemic required an unprecedented shutdown in our institutional LDCT program. The purpose of this study was to examine the impact of COVID-19 on lung cancer screening and subsequent cancer diagnosis. Study Design We analyzed our prospective institutional LDCT screening database, which began in 2012. In all, 2,153 patients have participated. Monthly mean number of LDCTs were compared between baseline (January 2017 to February 2020) and COVID-19 periods (March 2020 to July 2020). Results LDCT was suspended on March 13, 2020 and 818 screening visits were cancelled. Phased reopening began on May 5, 2020 and full opening on June 1, 2020. Total monthly mean ± SD LDCTs (146 ± 31 vs 39 ± 40; p < 0.01) and new patient monthly LDCTs (56 ± 14 vs 15 ± 17; p < 0.01) were significantly decreased during the COVID-19 period. New patient monthly LDCTs have remained low despite resuming full operations. Three- and 6-month interval follow-up LDCTs were prioritized and were significantly increased compared with baseline (11 ± 4 vs 30 ± 4; p < 0.01). The “no-show” rate was significantly increased from baseline (15% vs 40%; p < 0.04). Most concerning, the percentage of patients with lung nodules suspicious for malignancy (Lung-RADS 4) were significantly increased after screenings resumed (8% vs 29%; p < 0.01). Conclusions COVID-19 caused significant disruption in lung cancer screening, leading to a decrease in new patients screened and an increased proportion of nodules suspicious for malignancy once screening resumed. Using lung cancer and the LDCT screening program as a model, this early analysis showed the unrecognized consequences related to the pandemic for screening programs and cancer care.

Feasibility and Safety of Lung Cancer Screening and Prevention Program During the COVID-19 Pandemic

“…If public transport was needed, we requested screenees to undergo viral screening tests before the scheduled appointment to travel safely to and from INTM. Of the 845 contacted subjects, 534 (63.2%; 221 women, 41.4%; mean age; 62.1 AE 5.4 y) agreed to participate and attended one of the 13 sessions scheduled between October 17, 2020, and January 30, 2021, whereas 277 (32.7%) requested to either postpone the appointment or withdraw from the project, similarly to other reports 7,8 (Table 1). Participating subjects were evaluated with a median of only 1-month delay, as compared with their theoretic annual round.…”

Has COVID-19 Affected Cancer Screening Programs? A Systematic Review

“…Seventeen studies deemed eligible for the investigation were divided into the following four categories: cancer screening and pathology samples (3,8,14,16,17,27,28,(30)(31)(32)(33), cancer diagnosis in the COVID-19 period and factors related to the reduced diagnosis of cancer (8,17,26,27,31,34,35), impact of lockdown-related delay of medical care on tumor stage at the time of diagnosis (17,25,27,30,(32)(33)(34)(36)(37)(38), mortality rate and YLLs (17,38). Based on our review using the relevant checklist, 15 studies had good quality and 1 article had moderate quality.…”

“…COVID-19 has interrupted cancer screening such that, during the pandemic, reduced rates of cancer were reported from all screening programs (3,8,14,16,17,27,28,(30)(31)(32)(33). The effect was more pronounced in countries with a greater prevalence of COVID-19 or poorly controlled rates of COVID-19 infection.…”

“…The interruption of cancer prevention due to suspended cancer screenings may delay the diagnosis (17,25,33,34,36,37), increase the numbers of symptomatic patients (27), and disclose cancers in more advanced stages (36). In an investigation of 3184 patients, Ricciardiello et al concluded that a delay of 7-12 and > 12 months would lead to a significant 3% and 7% increase in the detection of advanced cancers (25) (Figure 2).…”

Invited Commentary

“…10 This is corroborated by the current report that observed a 21% increase in the number of patients with lung nodules suspicious for malignancy once their low-dose CT screening program reopened. 1 Follow-up data from the Van Haren group on the number of true lung malignancies and final staging will be important for our shared knowledge. With oncologic care delayed and potentially more advanced disease at time of presentation, the true morbidity and mortality rates of the viral pandemic might be vastly underappreciated.…”