Key points Has the national prevalence of breast, cervical, and colorectal cancer screening changed during the COVID-19 pandemic? Findings In this national survey study, between 2018 and 2020, the prevalence of past-year breast and cervical cancer screening decreased by 6% and 11%, respectively. There was no change in the prevalence of past-year colorectal cancer screening, with a 7% increase in stool testing and a 16% decrease in colonoscopy. Meaning These findings suggest that stool testing offset declines in colonoscopy during 2020, while breast and cervical cancer screening declined modestly. |
Summary
Importance
Healthcare was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased considerably, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported.
Aim
To examine changes in the prevalence of breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening using contemporary national Behavioral Risk Factor Surveillance System (BRFSS) data. in the population.
Design, environment and participants
This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women ages 50 to 74), CC (women ages 25 to 64), and CRC (women and men ages 50 to 75 years) screening. Data analysis was carried out from September 2021 to February 2022.
Main results and measures
Self-reported receipt of a recent BC, CC, and CRC screening test (defined as within the past year). Adjusted prevalence ratios (aPRs) comparing 2020 to 2018 prevalence and 95% CIs were calculated.
Results
In total, 479,248 people were included in the analyzes for BC screening, 301,453 people were included for CHD screening, and 854,210 people were included for CRC screening. In 2020, among respondents ages 50 to 75, 14,815 (11.4%) were Black, 12,081 (12.6%) were Hispanic, 156,198 (67.3%) were White, and 79,234 (29.9%) were graduated from college (all percentages are weighted).
After 4 years (2014-2018) of near-constant prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94 ; 95% CI, 0.92-0.96), and CHD screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91).
The magnitude of these decreases was greater in people with lower educational levels and Hispanic people. The prevalence of CRC screening remained stable; past-year stool testing increased 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95%, 0.82-0.88) between 2018 and 2020.
Conclusions and relevance
In this study, stool testing increased and offset a decrease in colonoscopy during 2020, and breast cancer and colorectal cancer screening decreased modestly.
It is not yet known how these findings might be associated with outcomes, but it will be important to monitor them, especially in populations with lower socioeconomic status, which experienced greater declines in screening during the COVID-19 pandemic.
Comments
New findings led by American Cancer Society (ACS) researchers show that the number of women in the United States who reported having recent breast cancer or cervical cancer screening ( in the last year) decreased by 2.13 million (6%) and 4.47 million. (11%) respectively in 2020 compared to 2018.
The study is the first of its kind to evaluate the impact of the COVID-19 pandemic on cancer screening nationwide using population-based data. The results are published in the Journal of the American Medical Association (JAMA) Open Network.
"The COVID-19 pandemic had an immediate impact in March and April 2020, as screening initially decreased by nearly 80%," said Dr. Ahmedin Jemal, senior vice president of surveillance sciences and equity at American Cancer Society health and senior author. from The Study. “Many people caught up with projections later in 2020, but overall, the COVID-19 pandemic kept projections low throughout the year. As we move forward, it is crucial that people return to their doctors’ offices to get tested.”
The study also found that between 2018 and 2020, colonoscopies for colorectal cancer screening in the past year decreased by 16% for both men and women, but this was offset by an increase in stool testing of 7%. . This showed the promise of at-home testing in maintaining population-wide screening rates during a major healthcare disruption.
In other findings of the study:
- Hispanic and low-income people experienced steeper declines in breast and cervical cancer screening last year, reflecting new emerging barriers and exacerbating long-standing barriers to cervical cancer screening. cancer.
- Asian/Pacific Islander women had a 27% drop in breast cancer screenings last year, the largest drop for any race.
- Hispanic women had a 17% drop in cervical cancer screenings last year.
- The drop in screening in the past year nearly doubled for those who did not graduate from high school compared to college graduates. High school graduates declined by 11% for breast cancer screening and 17.7% for cervical cancer screening, compared to 6.1% and 9.5%, respectively. , for college graduates.
“The impact on stage at diagnosis and survival is not yet known, but it is something we need to monitor closely,” Jemal said. “It is imperative that we understand the impact of lower screening rates on cancer outcomes among people of color and people of lower socioeconomic status and that we also work to improve access to health care and cancer screening.” cancer for everyone.”
“Regular cancer screening can help save lives. “This important study is further evidence of how important it is for people to get back on track with their regular screening after COVID-19,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. “Screening campaigns like our Get Screened campaign continue to aim to increase cancer screening rates by raising awareness about the need for recommended screening tests for breast, cervical, colorectal, prostate and lung cancer.”
Dahut adds: “Detection is safe, effective and accessible. Facilities offering screening services have COVID-19 safety precautions in place. “Many states have low-cost or reduced-cost screening programs to help ensure everyone has access, even people who don’t have insurance or a primary care doctor.”
Other ACS authors include: Jessica Star, Dr. Priti Bandi, Adair Minihan, Dr. Xuesong Han, and Dr. Robin Yabroff. Dr. Stacey Fedewa, now at Emory University, is the lead author of the study.
