COVID‐19 and inequities in colorectal and cervical cancer screening and diagnosis in Washington State

Abstract

Introduction Studies have shown that cancer screenings dropped dramatically following the onset of the coronavirus diseases 2019 (COVID‐19) pandemic. In this study, we examined differences in rates of cervical and colorectal cancer (CRC) screening and diagnosis indicators before and during the first year of the COVID‐19 pandemic. Methodology We used retrospective data from a large healthcare system in Washington State. Targeted screening data included completed cancer screenings for both CRC (colonoscopy) and cervical cancer (Papanicolaou test (Pap test)). We analyzed and compared the rate of uptake of colorectal (colonoscopies) and cervical cancer (Pap) screenings done pre‐COVID‐19 (April 1, 2019–March 31, 2020) and during the pandemic (April 1, 2020–March 31, 2021). Results A total of 26,081 (12.7%) patients underwent colonoscopies in the pre‐COVID‐19 period, compared to only 15,708 (7.4%) patients during the pandemic, showing a 39.8% decrease. A total of 238 patients were referred to medical oncology for CRC compared to only 155 patients during the first year of the pandemic, a reduction of 34%. In the pre‐COVID‐19 period, 22,395 (10.7%) women were administered PAP tests compared to 20,455 (9.6%) women during the pandemic, for a 7.4% reduction. period 1780 women were referred to colposcopy, compared to only 1680 patients during the pandemic, for a 4.3% reduction. Conclusion Interruption in screening and subsequent delay in diagnosis during the pandemic will likely lead to later‐stage diagnoses for both CRC and cervical cancer, which is known to result in decreased survival. Impact The results emphasize the need to prioritize cancer screening, particularly for those at higher risk.

The impact of the Covid-19 pandemic on Italian population-based cancer screening activities and test coverage: results from national cross-sectional repeated surveys

“…Studies from the US also showed increased inequalities consequent to the screening program interruption, with a larger impact in the decrease of screening uptake in rural areas and for beneficiaries of public insurance or those who are not insured at all. 31,32 Possible impact Many studies from Italy and other countries reported a delay in diagnoses for many cancer sites. 33 ,34 In some studies, a shift to more advanced stages and different initial therapeutic approaches have been observed for breast cancer and colorectal cancers.…”

“…Studies from the US also showed increased inequalities consequent to the screening program interruption, with a larger impact in the decrease of screening uptake in rural areas and for beneficiaries of public insurance or those who are not insured at all. 31, 32…”

Impact of COVID-19 on cancer screening: a global perspective

“…A significant drop in cancer screening computed tomography imaging in the United States (−49 to −81.7%) [ 32 , 37 ] and diagnostic radiology rates (−16%) was observed in Switzerland [ 17 ]. Reductions in cancer screening were reported for cervical cancer (−7.5 to −90%) in Canada, the United States, Brazil, France, Taiwan, Belgium, and 17 selected low- and middle-income countries (LMICs) [ 19 ▪ , 21 ▪ – 23 ▪ , 30 ▪▪ , 33 , 35 ▪ , 36 , 38 – 40 , 43 , 46 ]. A significant drop in digestive endoscopies (−19 to −29%) was reported in Lithuania and France [ 17 , 39 ].…”

“…A significant drop in digestive endoscopies (−19 to −29%) was reported in Lithuania and France [ 17 , 39 ]. Reductions in colon cancer screening (−8.1 to −95%) were registered in Canada, the United States, France, Belgium, Qatar, and 17 selected LMICs [ 14 , 15 , 16 ▪ , 23 ▪ , 25 , 30 ▪▪ , 33 , 35 ▪ , 36 – 39 , 43 , 44 ]. LCS rates fell in Canada, the United States, Ireland, and 17 selected LMICs (−21 to −44.6%) [ 11 , 24 , 30 ▪▪ ].…”

“…In Italy, Vigliar et al [ 29 ] reported a 41.6% reduction in the overall cytological sample workload compared with 2019. In particular, the workload declined significantly for each sample type: Pap tests, and/or HPV tests (–7.5–100%) in Italy and the United States [ 28 , 29 , 33 ]. The reductions in Italy were as follows: urine –42.8%; serous fluids –14.4%; breast –43%; lymph node –27.3%; and salivary gland –61% [ 29 ].…”