Millions of people in the U.S. missed cancer screening appointments during the second year of the COVID-19 pandemic, according to findings published February 23 in the Journal of Clinical Oncology.
Researchers led by Jessica Star from the American Cancer Society (ACS) found that about 4.4 million fewer women reported having cervical cancer screening, 1.1 million fewer women received breast cancer screening, and close to 700,000 thousand men reported skipping prostate cancer screening.
"The decline in breast, cervical, and prostate cancer screening rates may lead to a shift to late-stage diagnoses in the short-term and poor survival and increased mortality in the long-term," Star told AuntMinnie.com.
While overall decreases in cancer screening have been reported by previous research for 2020, the first full year of the COVID-19 pandemic, studies have also suggested that these numbers rebounded as the pandemic continued. But these reported rebounds are "not generalizable" to the overall U.S. population due to the numbers being based on claims databases, electronic medical records, or non-nationwide data, Star and colleagues wrote.
The authors assessed changes in the number of people receiving screening for breast, cervical, prostate, and colon and rectum cancer during the second year of the pandemic, as well as sociodemographic characteristics. They used data from the 2019 and 2021 National Health Interview Survey (NHIS), which they highlighted as a "true, national survey of the U.S. population."
Among survey participants in 2019 and 2021, respectively, 7,289 and 6,851 were eligible for breast cancer screening; 9,889 and 9,318 for cervical; 4,054 and 3,589 for prostate; and 13,989 and 12,938 for colorectal cancer screening.
The corresponding national population estimates were 49 million people in 2019 and 49.6 million people in 2021 for breast cancer screening; 81.3 million and 82.6 million people for cervical; 28.1 million and 28.5 million for prostate; and 95.7 million and 97.7 million for colorectal. The authors also reported that sociodemographic characteristics of survey participants were generally similar between the two surveys, except that the 2021 survey participants had slightly higher income (p = 0.04).
Between 2019 and 2021, overall past-year screening among eligible adults decreased by 6% for breast cancer, 15% for cervical cancer, and 10% for prostate cancer. Colorectal cancer screening numbers were relatively stable, owing to the increased use of at-home blood stool tests, the group noted.
| Cancer screening rate changes between 2019, 2021 survey results | ||||
| Cancer screening type | 2019 (% change) | 2021 (% change) | 2019 (Number of people who reported receiving screening) | 2021(Number of people who reported receiving screening) |
| Breast | 59.9% | 57.1% | 28.8 million | 27.7 million |
| Cervical | 45.3% | 39.0% | 35.9 million | 31.5 million |
| Prostate | 39.5% | 36.3% | 10.3 million | 9.7 million |
| Colorectal | 21.1% | 22.2% | 20.2 million | 21.7 million |
The researchers also found that between the two years, declines in breast, prostate, and colon cancer screening exams occurred mostly in the first three quarters of 2021.
By racial group, declines in cancer screening between 2019 to 2021 were largest for non-Hispanic Asians, with a range from 25% for breast cancer to 50% for prostate cancer. By poverty level, breast cancer screening prevalence during 2021 declined in all categories, and although not statistically significant, this trend was higher in women with a federal poverty level of less than 100% compared to those with a greater than or equal to 100% to 199% federal poverty level or with a greater than or equal to 200% federal poverty level.
Clinicians can play a major role in encouraging robust return to cancer screening by recommending it to each of their eligible patients according to guidelines, according to Star. She noted that her team plans to publish this year an updated review of major cancer risk factors and up-to-date information on cancer screening uptake during the COVID-19 pandemic, a document which it will release in tandem with the ACS' Cancer Prevention and Early Detection Facts and Figures 2023, she said.
