Investigators have found that monthly U.S. adult cancer diagnoses decreased by 50% early in April 2020 and that the largest decreases were observed for stage I tumors, resulting in a higher proportion of late-stage cancer diagnoses, according to a recent study published by Han et al in The Lancet Oncology. The findings may offer new insights into the impact that the first year of the COVID-19 pandemic had on cancer diagnoses and staging in the United States.
Background
“During the emergence of the pandemic, we know health care was disrupted in the [United States], and steep declines were reported for cancer screening services,” explained lead study author Xuesong Han, PhD, Scientific Director of Health Services Research at the American Cancer Society. “These updated results for all major cancer types nationwide represent a more comprehensive view and continue to be concerning, [since] decreased screenings as well as delayed and forgone routine checkups or [physician] visits can lead to underdiagnosis of cancer—especially in early stages, [when] treatment is most effective,” she emphasized.
Study Methods and Results
In the new study, the investigators used the latest national registry data to identify 2.4 million adult patients newly diagnosed with cancer—including 830,528 in 2018, 849,290 in 2019, and 724,232 in 2020.
The investigators found that the number of diagnoses for all stages of cancer decreased substantially following the emergence of the COVID-19 pandemic in the United States in March 2020; however, monthly counts returned to near pre-pandemic levels by the end of 2020. The decrease was largest for stage I diagnoses, leading to a higher rate of late-stage diagnoses in 2020 vs 2019. Although this pattern was seen in most cancer types and sociodemographic groups, it was most prominent among individuals who had historically experienced barriers to accessing health care—including those who were Hispanic, Asian American and Pacific Islander, uninsured, and residing in the most socioeconomically deprived areas.
Conclusions
“The estimates we present represent larger declines in the number of individuals diagnosed with early-stage cancers than in the number of individuals diagnosed with late-stage cancers,” underscored Dr. Han. “These findings likely reflect the time when individuals sought care or screenings during the pandemic rather than a stage shift in cancer progression. More ongoing cancer surveillance with longer-term data is warranted to better understand the full impact of the COVID-19 pandemic [on patients with cancer],” she concluded.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
