In a retrospective cohort study reported in JAMA Oncology, Ronald C. Chen, MD, MPH, and colleagues quantified cancer screening deficits in the United States associated with the COVID-19 pandemic and identified differences in deficits according to region and socioeconomic status.

Ronald C. Chen, MD, MPH

Study Details

The study involved data from the HealthCore Integrated Research Database, including information covering approximately 60 million people in Medicare Advantage and commercial health plans from geographically diverse regions. Study participants were individuals in the database in January through July of 2018, 2019, and 2020 without prior diagnosis of the cancer of interest. Changes in rates of screening for breast, colorectal, and prostate cancers were compared for corresponding months in 2019 and 2020 to determine the impact of COVID-19 on screening rates in 2020. 

Key Findings

Monthly screening rates for the three cancers were similar in 2018 and 2019. Compared with 2019, monthly screening rates declined markedly in March through May of 2020. The greatest declines were observed in April: 90.8% for breast cancer (from 4,287 to 394/100,000 enrollees), 79.3% for colorectal cancer (from 2,073 to 430/100,000), and 63.4% for prostate cancer (from 4,025 to 1,474/100,000). Declines in March and May were 41.8% and 52.6% for breast cancer, 33.3% and 57.7% for colorectal cancer, and 27.4% and 35.0% for prostate cancer.

Recovery of monthly screening rates compared with 2019 was nearly complete for breast and prostate cancers by July 2020, with a deficit of 13.1% still observed for colorectal cancer.

Despite the recovery in monthly screening rates observed in 2020, estimated total screening deficits in January through July 2020 vs the same period in 2019 for the entire U.S. population were 3.9 million individuals for breast cancer, 3.8 million for colorectal cancer, and 1.6 million for prostate cancer, yielding a total screening deficit of 9.4 million people.

Compared with 2019, the Northeast had the greatest declines in screening, and the West had a slower recovery compared with the Midwest and South. For example, declines in the breast cancer screening rate for April 2020 vs April 2019 ranged from 87.3% in the West to 94.5% in the Northeast. For July, declines vs 2019 ranged from 0.3% in the Midwest to 10.6% in West.  

According to socioeconomic status, the largest decline in screening rates in 2020 was observed in individuals in the highest socioeconomic status index quartile, which was associated with a narrowing in the disparity in cancer screening by socioeconomic status observed in 2019. For example, prostate cancer screening rates per 100,000 enrollees in the lowest and highest socioeconomic status index quartiles were 3,525 and 4,329 in April 2019 vs 1,535 and 1,338 in April 2020. Corresponding figures were 4,100 and 4,312 vs 546 and 292 for breast cancer, and 2,010 and 2,156 vs 521 and 376 for colorectal cancer.

On multivariate analysis, use of telehealth vs no use was associated with an increased likelihood of cancer screening, with significant risk ratios of 1.13, 2.46, 1.40, 1.25, and 1.22 observed in March through July 2020.

The investigators concluded, “Public health efforts are needed to address the large cancer screening deficit associated with the COVID-19 pandemic, including increased use of screening modalities that do not require a procedure.”

Dr. Chen, of the Department of Radiation Oncology, University of Kansas, Kansas City, is the corresponding author for the JAMA Oncology article.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.