Breast, colorectal cancer screening numbers rebound post-COVID

Breast and colorectal cancer screening in 2023 rebounded from declines during the COVID-19 pandemic and surpassed prepandemic screening estimates, according to findings published March 5 in JAMA.

Yet researchers led by Jessica Star from the American Cancer Society in Atlanta, GA, also found that cervical cancer screening numbers are still below prepandemic estimates, and that improvements in cancer screening rates were mostly seen in individuals with higher socioeconomic status.

“Improving patient communication around cancer screening and providing patient navigators to assist with the structural and cost barriers to screening are two ways health systems can help with successful screening rebounds,” Star told AuntMinnie.com.

The COVID-19 pandemic caused disruptions in cancer screening as facilities temporarily shut down according to social distancing guidelines and reallocated resources to fight the pandemic. Radiologists have expressed concern in recent years about the downstream effect these actions may have on later-stage cancer trends, since many screening appointments were postponed or canceled altogether.

Previous reports indicate that screening numbers in the U.S. did not fully rebound in 2021, one year after the pandemic was declared in March 2020.

Star and co-authors estimated postpandemic cancer screening rates in 2023, comparing them to declines documented in 2021. They used data from the Nationa Health Interview Survey, comparing cancer screening between 2019 and 2023 and between 2021 and 2023. The study included 2023 data from 6,829 women eligible for breast cancer screening, 8,888 for cervical cancer screening, and 13,144 for colorectal cancer screening.

The investigators found the following:

• Reported past-year breast cancer and colorectal screening increased between 2019 and 2023 by 7% and 12%, with adjusted prevalence ratios (aPRs) of 1.07 and 1.12, respectively (with 1 as reference).
• Breast and colorectal cancer screening rebounded between 2021 and 2023, with aPRs of 1.14 and 1.13, respectively. Stool testing increased from 6.6% in 2019 to 10.1% in 2021 and 2023.
• Reported cervical cancer screening in 2023 remained 14% below 2019 estimates (aPR, 0.86) and unchanged from 2021.
• Colorectal cancer screening jumped by 17% between 2019 and 2023 among college graduates, but did not significantly increase among individuals with a high school degree or less.
• Breast cancer screening met or exceeded 2019 levels across education-level groups as screening rebounded by 10% to 28% between 2021 and 2023.
• By insurance, both breast and colorectal cancer screening increased by 6% to 15% between 2019 and 2023 in individuals with private and Medicare insurance. This did not significantly change in individuals without insurance.
• Cervical cancer screening increased by 8% between 2021 and 2023 in college graduates. However, this screening type remained below 2019 levels for most education levels and types of insurance.

Star cited a 2022 study that showed declines in cervical cancer screening prior to the COVID-19 pandemic; these were associated with decreases in patient knowledge and provider recommendations for screening.

“The declines in cervical cancer screening through 2023 may reflect persistent declines in patient knowledge and communication around cervical cancer screening both during and after the COVID-19 pandemic,” Star said.

She added that clinicians can use this information to better understand who is still missing out on cancer screening after the COVID-19 pandemic.

“Hopefully, this can inform where additional attention or resources might be needed to improve cancer screening rates,” she told AuntMinnie.com.

In late April, Star and colleagues plan to release a report titled, Cancer Prevention & Early Detection Facts & Figures 2025-2026, an educational document that provides updated information on cancer risk factors and up-to-date cancer screening.

The full study can be found here.