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05-03-2021 | Oncology | News | Article

Marked dip in cancer screens at start of COVID-19 outbreak

Author: Shreeya Nanda

medwireNews: The early months of the COVID-19 pandemic saw a steep reduction in the number of people undergoing cancer screening tests, although numbers recovered subsequently, suggest data from northeastern USA.

Using data from the Massachusetts General Brigham healthcare system, the researchers found that 15,453 individuals underwent one of five screening tests – namely low-dose CT, Papanicolaou test, colonoscopy, prostate-specific antigen (PSA) screening, and mammography – during the first peak of the pandemic in March 2–June 2, 2020, with diagnosis of cancerous or precancerous lesions in 1985 cases.

This was “a significant decrease” compared with the 64,269 tests (3423 diagnoses) recorded in the preceding 3 months and the 60,344 tests (2961 diagnoses) conducted between March 2–June 2 in 2019, they report in a research letter to JAMA Oncology.

But reassuringly, the number of people undergoing screening rose to “almost prepandemic levels” in the 3 months (June 3–September 3, 2020) after the first peak, at 51,944 tests (3190 diagnoses), write Quoc-Dien Trinh (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and colleagues.

The percentage decreases in uptake of screening tests during the pandemic versus control periods were “pronounced” for all five tests (60–82%), as were the percentage decreases in diagnoses resulting from screening tests (19–78%), note the study authors.

However, a higher proportion of screening tests were positive during the first peak of the pandemic than in any of control periods for PSA screenings (22.7 vs 9.9–13.2%), cervical smears (11.6 vs 6.5–10.0%), mammograms (4.1 vs 1.9–2.3%), and colonoscopies (1.3 vs 0.7–0.9%), although the rates were comparable for low-dose CT scans (0.8 vs 0.7–0.8%).

The team also estimated the number of “missed” diagnoses during the pandemic period, finding that approximately 1438 could be considered as missed, based on the number of tests and diagnoses in the 3 months prior to the first peak.

“[T]he number of potential “missed” diagnoses during the primary pandemic period were likely lower than would have been expected because the percentage of screening tests leading to a diagnosis of a cancerous or precancerous lesion was higher during the primary pandemic period, which may reflect the prioritization of high-risk patients for cancer screening during the pandemic,” say Trinh and colleagues.

Commenting on the results for medwireNews, Howard (Jack) West, from City of Hope Comprehensive Cancer Center in Duarte, California, USA, said that “we should anticipate that lower cancer screening will translate to more cases being detected at a higher stage and with less favorable outcomes when the diagnosis is ultimately made by patient symptoms rather than asymptomatic screening.”

But he also thinks that “the pandemic will provide a rare opportunity to clarify the true value of cancer screening in the real world by being able to track the actual impact of changing screening patterns on actual cancer diagnoses and outcomes over time,” noting that this will likely need to be evaluated “by specific cancer and screening modality, as I suspect there is actually considerable variability across them.”

Finally, West highlighted the need for healthcare systems to “ensure they are ‘open for business’ and convey a message that cancer screening remains appropriate and available for the populations they serve, rather than relegating screening as a secondary or tertiary process to be deprioritized.”

He continued: “While there may have been an early hope that COVID-19 would be a transient threat and that less time-sensitive activities could be deferred, we must now recognize that we need to proceed with a mindset that we cannot expect to ‘wait out’ the pandemic.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

5 March 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

JAMA Oncol 2021; doi:10.1001/jamaoncol.2020.7600

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