Expert: Cancer Screening Rates in 2021 Remain Lower Than Expected

Pharmacy Times interviewed Christopher Mast, MD, vice president of clinical informatics at Epic, on research demonstrating that despite cancer screening rates rebounding in 2021 from the low rates at the beginning of the pandemic, they were still lower than experts in the field had expected.

Pharmacy Times: What did the study findings show regarding the rates of cancer screenings in 2021?

Christopher Mast: Well, we saw some early things that didn't surprise us. In fact, this is the fourth in a series of articles that we've been doing, and the part that didn't surprise us was near the very beginning of the pandemic. We saw a dramatic decrease in the amount of routine cancer screening that was taking place—something like a 94% decrease in breast and cervical cancer screening and an 86% decrease in the expected level of colon cancer screening, and that wasn't super surprising.

If you recall—it's been some time now—but towards the beginning of the pandemic, we all learned in fairly short order that it was potentially dangerous to be around people, and so the idea of going in for routine screening—people seemed to have put that off at least for a while. At the same time, health care organizations were really trying to pull together and rally to confront this new challenge, and some routine things, again, were put off. They said, Hey, we're focused on taking care of the acutely ill, let's wait a little while. So, we saw that dramatic decrease.

What we were anticipating is that after that decrease leveled, we might see a catch-up period, as it were, where all of those people who had deferred screening would come in and try and get that done—we didn't actually see that. So, we continued, as I said, over a series of investigations to look to see if that was going to occur, and, it hasn't.

In fact, cancer screening rates, as you said, have rebounded to near the levels of what they were before the pandemic, but they're still a little bit lower than expected, and that was something of a surprise to us.

Pharmacy Times: Why might these rates not have increased in 2021 quite as much as expected?

Christopher Mast: Well, for the strict data collection for the article, all we have are those numbers, but we do have some thoughts about why that might be. For one thing, I think our initial thought that there would be a rebound was sort of formed with the idea that the pandemic would be more or less resolved by the end of 2020. As we all well know, we learned over time that that wasn't the case as, in fact, we've had repeated surges and things have stretched on.

Good news, obviously with immunizations and so forth and things sort of leveling out, but of course, additional variants coming up—so things have stretched, and we haven't gotten to a place I think where people have said, Hey, everything is back to normal, I'm going to go back to my usual routine, get in, get all of my cancer screening done.

As I said, the levels have come up to nearly what they were before the pandemic—something like 2% to 3% less than we would expect so far, actually, throughout 2021 for breast and colon cancer screening for cervical cancer screening. It's a little bit lower at about 10% less total screening was done throughout 2021 than we would have expected, based on historical levels.

So, we haven't seen that rebound, I think, that may be because the pandemic has continued to be a factor, and I think that is something that—as we continue to look at it—we hope more and more people become aware of, that as time goes on, the risk of putting off that screening, if people are doing that, continues to grow.

Obviously, screening is intended to pick up cancers early on when they are not as advanced, when they haven't spread, and when they're more easily treatable. So as people continue to defer screening, potentially, that could be a cancer that won't be detected till later on when it's more difficult to treat.