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.
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.
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.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.