Cancer Screening Rates Intermittently Recovered After Initial Phase of COVID-19 Pandemic

Rates of low-dose computed tomography (LDCT) and mammography screenings decreased as national COVID-19 infection rates increased, according to data from a paper recently published in JAMA Network Open. Rates of LDCT scans were 24% lower than expected from March 2020 to February 2021, and rates of mammography screening were 17% below the expected rate, the study authors observed.

“Delays in cancer screening can contribute to delays in diagnosis and increased deaths from cancer,” the study authors wrote. But for many, “decreases in cancer screening during the early phases of the COVID-19 pandemic did not resolve after the initial pandemic surges.”

There was also an association between lower prepandemic screening rates and patients of low income or historically marginalized race/ethnicity. These patients were found to have a worse rate of recovery after screening rates first depressed at the beginning of the COVID-19 pandemic.

Cancer screening rates diminished early in the pandemic but recuperated to normal or almost normal during the summer of 2020. However, limited reports on screening rates have opposing data, are limited to 1 institution or hospital system, or do not account for screening trends prior to the pandemic.

Investigators of the current study sought to gather more long-term data to better understand whether cancer screening rates remained lower during the latter part of the pandemic. Using national Medicare data, the team graphed the unadjusted monthly screening rates of mammography and LDCR screening data from January 2017 through July 2022.

In the 3 years leading up to the COVID-19 pandemic, experts hypothesized that the flat mammography rates and increased LDCT screening rates of the prepandemic would show a similar trend during the pandemic.

Although normal LDCT rates were observed during months of low COVID-19 rates, LDCT rates were “depressed in months with higher COVID-19 rates,” the authors wrote in the paper. This shows an association between lower-than-expected screening rates and COVID-19 infection surges well into late 2021 and early 2022, according to the study.

In early 2017, rates of LDCT screening were 500 per 1 million enrollees per month, which grew to 1100 per 1 million enrollees by January 2020, then depressed during the early pandemic. By January 2021, LDCT rates were 30.5% lower than projected and 28.3% lower the following year.

Mammography rates had smaller dips but followed this trend, as they were 14.6% and 14.2% lower than expected in January 2021 and January 2022, respectively. Additionally, patients of a younger age, non-White Hispanic ethnicity, and being eligible for Medicaid were each independently associated with a lower observed rate of screening during the first year of the pandemic, according to data from multivariable analyses.

Investigators could not identify the true denominator for finding cancer screening rates, which was a limitation. Additionally, participants were limited to fee-for-service Medicare recipients and not reflective of the general population. Finally, a drop in screening rates cannot be directly linked to a lack of mammography screenings.

“More widespread recognition of the slow recovery from pandemic-related deficits in cancer screening should lead to more focused efforts to remedy the deficits,” the study authors wrote. “Successful interventions to improve screening rates should address pandemic-specific reasons for low screening participation.”

Reference

Doan C, Li S, Goodwin J. Breast and Lung Cancer Screening Among Medicare Enrollees During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(2):e2255589. doi:10.1001/jamanetworkopen.2022.55589