Low Cancer Screening Rates Persist 2 Years Into Pandemic

Cancer screenings for colon and breast cancer remain below baseline, and rates for cervical cancer screening are lower than expected, according to data from a study by Epic Research. Routine cancer screenings were significantly affected at the beginning of the COVID-19 pandemic, but investigators had predicted improvements would occur following the first year.

At the beginning of the pandemic, the data demonstrated a 94% decrease in breast cancer and cervical cancer screenings and an 86% decrease in colon cancer screenings. Overall, cancer screening rates rallied slightly in 2021 but are lower than investigators expected.¹

For populations who already experience health inequities, missed or delayed breast and cervical cancer screenings can lead to delayed diagnoses, poor health outcomes, and an increase in cancer-related disparities.² For these patients, the lack of a rebound to normal screening rates could have significant health implications.

Several factors contributed to the sharp decrease in screening rates, including screening site closures and recommendations for patients to stay home. Additionally, the fear of contracting COVID-19 likely contributed to patients’ hesitancy about seeking out health care services.²

“If you recall—it’s been some time now—but toward 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 a routine screening [was one that] people seemed to have put...off, at least for a while,” said Christopher Mast, MD, vice president of clinical informatics at Epic, in an interview with Pharmacy Times®.³

Two years after the onset of the pandemic, clinicians are still expressing concerns that screening rates have not returned to their prepandemic levels. According to the Epic Research findings, rates of breast and colon cancer screenings remain at 2.7% and 3.4% below baseline, respectively. Addition- ally, cervical cancer screening rates are 10% below historical baselines.¹

Between January and October 2021, these rates amounted to an estimated 68,000 missed breast cancer screenings, 27,000 missed colon cancer screenings, and 9000 missed cervical cancer screenings.¹

“What we were anticipating is that after that decrease leveled, we might see a catch-up period, as it were, where all those people who had deferred screenings would come in and try to get that done, [but] we didn’t actually see that,” Mast said.³

Furthermore, these decreased screening rates could affect women of color in particular, according to a CDC news release. Between January and June 2020, declines in breast cancer screening rates were significant among Hispanic women and American Indian/ Alaskan Native women at 84% and 98%, respectively. Similarly, declines in cervical cancer screenings ranged from 82% among Black women to 92% among Asian Pacific Islander women.²

In April 2020, CDC investigators assessed the decline in screening tests by area, finding the rates of breast cancer declines in metropolitan (86%), urban (88%), and rural (89%) areas in relation to their respective 5-year averages. For cervical cancer screening tests, the decline was 85% in metropolitan areas, 82% in rural areas, and 77% in urban areas in comparison with 5-year averages.²

By June 2020, at the end of the study’s observation period, screening volumes had begun to recover. However, they did not return to prepandemic rates.²

“This study highlights a decline in cancer screening among women of racial and ethnic minority groups with low incomes when their access to medical services decreased at the beginning of the pandemic,” said lead author and CDC health scientist Amy DeGroff, PhD, MPH, in the news release. “[The data] reinforce the need to safely maintain routine health care services during the pandemic, especially when the health care environment meets COVID-19 safety guidelines.”²

To address the decline in colon cancer screenings in 2020 and 2021, according to Epic study data, rates would need to exceed the historical weekly average
by more than 3800 screenings per week in 2022. Similarly, weekly cervical cancer screening rates would need to exceed the historical average by at least 230 per week.

With breast cancer screenings typically recommended annually, Mast said providers should work with patients to get back onto regular screening schedules in 2022.¹

“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,” he noted. “So as people continue to defer screening, ... that could [mean] a cancer...won’t be detected until later on when it’s more difficult to treat.”³

References

1. Mast C, Deckert J, Muñoz del Rio A. Troubling cancer screening rates
still seen nearly two years into the pandemic. Epic Research. January
18, 2022. Accessed February 14, 2022. https://epicresearch.org/articles/ troubling-cancer-screening-rates-still-seen-nearly-two-years-into-the-pandemic

2. Sharp declines in breast and cervical cancer screening. News release. CDC. June 30, 2021. Accessed February 14, 2022. https://www.cdc.gov/media/releases/2021/ p0630-cancer-screenings.html

3. Expert: cancer screening rates in 2021 remain lower than expected. Pharmacy Times®. February 2, 2022. Accessed February 14, 2022. https://www.pharmacytimes.com/view/ expert-cancer-screening-rates-in-2021-remain-lower-than-expected