In a U.S. cross-sectional study reported in JAMA Oncology, Oakes et al found that as of December 2021, breast, cervical, and colorectal cancer screening rates remained below pre–COVID-19 pandemic levels, despite initial rebounds in some rates. Reduced screening rates were accompanied by reduced reported prevalence rates.
Study Details
The study used the Trilliant Health all-payer claims and encounters database, covering the entire United States, to analyze calendar year quarterly medical claims from January 2017 to December 2021.
Key Findings
The analysis included 306 million individuals with a mean age of 51.5 years.
For breast cancer, the median quarterly rate of prepandemic screening of 8,216 per 100,000 beneficiaries decreased to 4,951/100,000 in quarter (Q)2 of 2020 (40% decrease). Screening rates increased to the prepandemic level by Q3 and Q4 of 2020, and then declined to 7,374/ 100,000 in 2021, with quarterly deficits ranging from 6% to 17%. In the context of reduced screening, the reported prevalence of breast cancer decreased by approximately 6% between 2019 and 2020 and by an additional approximately 5% between 2020 and 2021.
For cervical cancer, the median quarterly rate of prepandemic screening of 5,602/100,000 decreased to 3,563/100,000 in Q2 of 2020 (36% decrease). Rates increased toward the prepandemic level by Q3 of 2020, and then declined to 4,853/100,000 in Q4 of 2020 and 4,246/100,000 in Q4 of 2021. The reported prevalence of cervical cancer decreased by approximately 6% between 2019 and 2020 and by an additional approximately 5% between 2020 and 2021.
For colorectal cancer, the median quarterly rate of prepandemic screening of 3,162/100,000 decreased to 1,746/100,000 in Q2 of 2020 (45% decrease). From Q3 of 2020 to Q4 of 2021, quarterly screening rates ranged from 2,590 to 2,861/100,000 beneficiaries—levels that were 82% to 90% of the prepandemic level. The reported prevalence of colorectal cancer decreased by approximately 7% between 2019 and 2020 and by an additional approximately 6% between 2020 and 2021.
The investigators stated, “In this cross-sectional study, population-based screening and diagnosis remained below prepandemic levels for the three cancer types. The findings suggest that screening quickly rebounded after the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened…. The pattern we found suggests a substantial proportion of forgone care through 2021. To mitigate long-term consequences, multiple stakeholders will need to consider novel strategies and dedicate appropriate resources to increase guideline-concordant cancer screening.”
Allison H. Oakes, PhD, of the Department of Research, Trilliant Health, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
