Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic

Disparities in Colorectal Cancer Screening and Diagnoses in the COVID Era: A Study of the VA Health System

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic caused disruptions in cancer screening and diagnosis, including colorectal cancer. Given disparities in cancer and COVID-19 faced by historically disadvantaged minorities, we examined changes in disparities in colorectal cancer screening and diagnosis in the COVID era.

PATIENTS AND METHODS

In a cohort study using the Veterans' Affairs Health Care System (VAHCS) from 2018 through 2021, we quantified colonoscopies, fecal occult blood tests (FOBT), and new diagnoses of colorectal cancer (CRC) by month from 1 March 2018 to 31 December 2021. We compared the pre-COVID (before 1 March 2020) to the COVID (1 March 2020 and after) era. We graphed temporal trends by age, sex, race, ethnicity, rural-urban, and socioeconomic status (SES). Logistic regression was used to evaluate temporal trends after adjusting for confounders.

RESULTS

During the study period, there were about 900,000 colonoscopies, 1.4 million FOBTs, and > 30,000 new diagnoses of CRC. Colonoscopies and new CRC decreased dramatically during the early COVID era to < 10% and < 60% of pre-COVID rates, respectively. Although we identified a modest increase in disparities of colonoscopy use among Black and Latino patients in the early COVID era, these increased disparities did not persist in adjusted analysis. We did not identify changes in disparities in FOBT use or new CRC diagnoses.

CONCLUSIONS

We did not identify increased disparities in CRC screening or diagnoses by age, sex, race, ethnicity, geographic region, or SES in the VAHCS. These results indicate a potential strength of the VAHCS and require further study in additional cancers and healthcare systems.

Trends in socioeconomic inequalities in cancer screening participation before and after the COVID-19 pandemic in Japan

BACKGROUND

Socioeconomic inequalities in cancer screening participation remain a public health issue worldwide. We assessed trends in cancer screening participation according to socioeconomic status in Japan between 2013 and 2022, considering the potential impact of the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Data from the nationally representative Comprehensive Survey of Living Conditions (2013-2022: approximately 500,000 persons per survey) were analyzed for age-standardized self-reported cancer screening rates for stomach, lung, colon, breast (aged 40-69 years), and cervical (aged 20-69 years) cancers, stratified by education levels. An age-adjusted Poisson model was used to assess the statistical significance of changes between the survey years.

RESULTS

A clear socioeconomic gradient was observed, particularly in stomach cancer screening, where the 2022 rates ranged from 28.3% (low education) to 58.2% (high education) for men and 20.2% to 43.2% for women, depending on education level. Between 2019 and 2022, screening rates for stomach, lung, and colorectal cancers changed by -1.2%, -0.9%, and +0.6% for men and -1.0%, +0.1%, and +1.4% for women, respectively. Breast and cervical cancer screening rates declined by 0.5% and 0.4%, respectively. The COVID-19 pandemic worsened inequalities, with a 3.1% decline in breast cancer screening among individuals with low education level, compared to a 1.0% decline among those with higher education level.

CONCLUSIONS

The COVID-19 pandemic had a minor impact on screening rates (counteracting increasing trends of screening rates), except for colorectal cancer screening rates; however, the impact was relatively severe for individuals with lower socioeconomic status, especially for women.

A difference-in-differences analysis of Medicaid expansion and state paid sick leave laws on colorectal cancer screening

BACKGROUND

Colorectal cancer (CRC) screening disparities persist among populations with limited health care access. Although Medicaid expansion and paid sick leave could address these barriers, there is limited data on the combined impact of these policies and CRC screening.

METHODS

The authors conducted a difference-in-differences analysis using 2012-2018 Behavioral Risk Factor Surveillance System data. The study population included adults 50-75 years of age meeting preventive cancer screening guidelines during the study period. States were categorized into three groups: those with Medicaid expansion and paid sick leave (ME + SL), Medicaid expansion without paid sick leave (MEnoSL), and neither policy (NoME/NoSL). The pre-policy period was 2012-2014 and the post-policy period was 2015-2018. The outcome was the percent up-to-date with CRC screening. Survey-weighted logistic regression models accounted for individual- and state-level covariates and state-clustered standard errors.

RESULTS

Post-policy implementation, CRC up-to-date screening was 2.9 percentage points greater in ME + SL states compared to MEnoSL states (p < .001) and 4.2 percentage points greater compared to NoME/NoSL states (p = .018). These changes correspond to an estimated 352,343 and 1,087,140 fewer missed screenings between ME + SL and MEnoSL and NoME/NoSL states, respectively. The increased percent of up-to-date CRC screenings was associated with a reduction in colorectal cancer deaths: 8456 from ME + SL versus MEnoSL and 26,091 from ME + SL versus NoME/NoSL.

CONCLUSIONS

Medicaid expansion combined with paid sick leave was associated with a greater likelihood of being up-to-date with CRC screening compared to Medicaid expansion alone or neither policy.

Cancer Screening 3 Years After the Onset of the COVID-19 Pandemic

This study examines post–COVID-19 pandemic cancer screening rates in 2023 relative to previously documented declines through 2021.

Effects of COVID-19 pandemic on breast cancer screening: A 6-year cohort study

ObjectiveBreast cancer screening facilitates the early detection of breast cancer and can reduce mortality among women. However, during the COVID-19 pandemic, regular screening was postponed or interrupted. This study investigated the effect of the pandemic on breast cancer screening and diagnosis rates.MethodsThis single-center, retrospective cohort study enrolled women aged 40-69 years. Mammography was performed at our hospital or in outreach screening vehicles. Follow-up rate, time to follow-up, time to diagnosis, cancer detection rate (CDR), positive predictive value (PPV), and cancer staging were compared between pre-pandemic (2017-2019) and pandemic (2020-2022) periods.ResultsA similar number of participants were screened during the pandemic (N = 77,901) and pre-pandemic periods (N = 75,403). However, mobile screening significantly increased from 89.4% to 94.9% during the pandemic. Education level, rate of self-examination of breasts, and the proportion of participants with a family history of breast cancer were higher during the pandemic than in the pre-pandemic period. Time to follow-up and time to diagnosis were significantly shorter during the pandemic than in the pre-pandemic period. No significant differences were observed in PPV, CDR, cancer staging, and rate of invasive carcinoma between the two periods.ConclusionDuring the pandemic, participants were more likely to promptly return for follow-up. The use of outreach screening vehicles and increased awareness for individuals with low education levels are crucial for maintaining screening volumes in the pandemic recovery period. Outreach screening strategies may serve as an alternative in a future pandemic crisis.

Changes in Breast and Cervical Cancer Incidence by Stage at Diagnosis During the COVID-19 Pandemic in Utah

PURPOSE

The COVID-19 pandemic caused unprecedented disruptions in healthcare access, resulting in significant delays in breast and cervical cancer screening and diagnostic services. This study examined whether there were changes in the stage of diagnosis for breast and cervical cancers diagnosed among Utah women during the pandemic compared to years prior to the pandemic.

METHODS

Patients included adult females with a new breast or cervical cancer diagnosis reported to the Utah Cancer Registry, diagnosed from January 2020 to December 2021 (pandemic time period) or between January 2018 and December 2019 (pre-COVID-19). We calculated age-adjusted incidence rates and incidence rate ratios (IRRs) with 95% confidence intervals (CI) to compare stage at diagnosis and sociodemographic factors between time periods.

RESULTS

A total of 308 cervical cancer cases and 8215 breast cancer cases were diagnosed throughout the duration of the study. Overall incidence of cervical cancer was higher during the pandemic, driven primarily by distant-stage disease incidence, which was more than three times higher than before the pandemic (IRR, 3.11; 95% CI, 1.67-5.79). Non-Hispanic (NH) White women were significantly more likely to be diagnosed with late-stage cervical cancer (IRR, 1.60; 95% CI, 1.12-2.30) during the pandemic compared to pre-pandemic. Local-stage breast cancer incidence decreased slightly during the pandemic compared to pre-pandemic (IRR, 0.93; 95% CI, 0.88-0.99). Hispanic women saw a slight increase in late-stage breast cancer incidence during the pandemic compared to before the pandemic (IRR, 1.31; 95% CI, 1.03-1.67).

CONCLUSIONS

We saw a significant increase in the incidence of late-stage cervical cancer during the pandemic compared with pre-pandemic. Conversely, while local-stage breast cancer incidence was slightly lower during COVID-19 compared with pre-COVID-19, no difference was observed among all other stages. More time is needed to assess the full impact of COVID-19 on breast and cervical cancer trends.

Association Between Pre-Diagnostic Delay and Survival Among Patients With Esophageal and Gastric Cancer Treated With Curative Intent During the COVID19 Pandemic

BACKGROUND

The majority of esophageal and gastric cancers are diagnosed at an advanced stage with poor overall survival (OS). Whether the pre-diagnostic interval from symptom onset has any impact on OS is unclear. We investigated this question in the peri-COVID19 pandemic era.

METHODS

We retrospectively analyzed a cohort of 308 patients with esophageal, gastroesophageal junction, or gastric carcinoma treated with curative intent at the Princess Margaret Cancer Centre from January 2017 to December 2021. Clinical details pertaining to the initial presentation were determined through a retrospective chart review. Cox proportional hazards regression models were used to assess the association between pre-diagnostic intervals and OS, adjusting for baseline patient characteristics.

RESULTS

The median interval from symptom onset to diagnosis was 98 days (IQR 47-169 days). Using a cox proportional hazard model, prolonged pre-diagnostic interval was not associated with worse OS (HR 1.00, p = 0.62). Comparing patients diagnosed before and during the COVID19 pandemic, there was a notable increase in diagnostic delay with median pre-diagnostic interval increasing from 92 to 126 days (p = 0.007). Median age at time of diagnosis was 69.6 during the pandemic vs. 64.7 before the pandemic. Linear regression showed squamous cell histology was significantly associated with increasing time to initial diagnosis (p = 0.04), but this did not hold true in a multivariable model. Looking at other delay metrics, there were no changes in time interval from diagnosis to treatment during versus before the pandemic (median = 1.7 weeks for both), and there was no change in time from diagnosis to resection in those patients who underwent surgery.

CONCLUSION

The COVID19 pandemic caused significant diagnostic delay for patients presenting with curative gastroesophageal and gastric cancer. The lack of correlation of pre-diagnostic interval with OS may reflect underlying tumor biology as the driving force that determines prognosis.

Perceived Discrimination and Pandemic Attitudes on Cancer Screening Behaviors Among Asian American Women: A Sequential Explanatory Mixed-Methods Study

PURPOSE

The aim of this study was to assess how pandemic-related health concerns and discrimination affected cancer screenings among Asian American women (AAW).

METHODS

A two-phase explanatory mixed-methods study was conducted. In phase 1, a survey was distributed among AAW eligible for lung, breast, or colorectal cancer screening to assess delays during the pandemic, concerns about contracting coronavirus disease 2019 (COVID-19), barriers to care, and experiences of discrimination. In phase 2, four qualitative focus group discussions, stratified by generational status and history of delayed cancer screening, were conducted to explore a priori domains of interest on cancer screening during the pandemic and perceived discrimination. Logistic regression analyses were performed to identify factors associated with delays, followed by deductive thematic qualitative analysis.

RESULTS

In phase 1, of 225 participants recruited, 166 met the inclusion criteria (74%). Most participants were first-generation Americans (67%), were employed (65%), and had higher education (67% with a master's degree or higher). Forty percent reported delays in cancer screening. Factors associated with delays included worry about contracting COVID-19 (adjusted odds ratio, 2.57; 95% confidence interval, 1.05-6.28; P = .038) and spreading it to family or friends (adjusted odds ratio, 5.78; 95% confidence interval, 1.50-22.3; P = .011). No association between discrimination and delayed cancer screening was found. In phase 2, focus group discussions (n = 19) revealed that first-generation women who delayed screening faced barriers due to a fear of infection and perceived discrimination. Perceived discrimination affected daily behaviors and sense of safety, though less so in medical settings.

CONCLUSIONS

Delays in cancer screening among AAW were associated with patients' concerns about contracting and spreading COVID-19. Radiology practices can lead collaborative efforts on cancer screening campaigns that emphasize early detection and promote psychological safety.

Annual Report to the Nation on the Status of Cancer, featuring state-level statistics after the onset of the COVID-19 pandemic

BACKGROUND

This report represents a collaborative effort by the major cancer surveillance organizations to present the definitive US statistics for cancer incidence and mortality.

METHODS

Cancer incidence data were obtained from population-based cancer registries funded by the Centers for Disease Control and Prevention and the National Cancer Institute and compiled by the North American Association of Central Cancer Registries. Cancer death data were obtained from the National Center for Health Statistics' National Vital Statistics System. Statistics are reported by cancer type, sex, race and ethnicity, and age. The potential impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence was assessed by using state-level changes compared with previous years, the stringency of COVID-19 policy restrictions, the magnitude of COVID-19 death rates, and changes in the use of mammography.

RESULTS

Overall cancer incidence rates per 100,000 were 500 among males and 437 among females. Excluding 2020, cancer incidence rates remained stable (2013-2021) among males and increased 0.3% per year on average (2003-2021) among females. The overall cancer death rate per 100,000 was 173 among males and 126 among females. Cancer death rates decreased by 1.5% per year (2018-2022), slowing from a previous 2.1% decline. Cancer incidence in 2020 declined from prepandemic levels for all demographic groups examined. However, the magnitude of decline was not strongly associated with the study's proxies for health care capacity, health care access, or COVID-19 policies.

CONCLUSIONS

Overall cancer mortality declined over 20 years, even during the COVID-19 pandemic. Disruptions in health care use early in the pandemic resulted in incidence declines in 2020, but 2021 incidence returned to prepandemic levels.

Initial and persistent changes in cancer screening in a US Midwestern community health center network following the onset of COVID-19

Objective

To assess longer-term change in breast, cervical, and colorectal cancer screening among Community Health Centers (CHCs) following onset of COVID-19.

Methods

Among 27 CHCs in the US Midwest, we examine trends in standard electronic clinical quality measures and test-volume based cancer screening measures from January 2019 through October 2021. Test-volume measures include the number of cancer screening tests completed, the difference between the actual versus expected cumulative number of tests completed (i.e. pandemic screening gap), and the recent testing ratio (i.e. proportion of individuals up-to-date on screening who completed testing in the past year).

Results

Standard cancer screening quality measures showed only modest changes. In contrast, test-volume measures show large and persistent deficits. After a sharp drop in screening activity in early 2020, activity resumed but failed to reach pre-pandemic levels. As a result, the pandemic screening gap continued to grow larger over time reaching approximately 5400 fewer breast, 8600 fewer cervical, and 4500 fewer colorectal cancer screenings performed. This represents a 16-18 % deficit in the number of tests and is the equivalent of 3.5-4.0 months of dedicated pre-pandemic cancer screening activity. The recent testing ratio also decreased in 2020 and also failed to return to pre-pandemic levels.

Conclusions

Following onset of COVID-19, there was a persistent negative change in cancer screening in our CHC network. This change is more evident when examining test-volume compared to standard quality metrics. Understanding and addressing the persistent pandemic cancer screening gap is critical to limit health burdens and disparities related to cancer.

Functional Limitations and Use of General Health Examination and Cancer Screening Among People with Disabilities Who Need Support from Others: Secondary Data Analysis of the 2022 Comprehensive Survey of Living Conditions in Japan

Functional limitations that compromise preventive healthcare service utilization by people with disabilities in Japan are unelucidated. Secondary data from the Comprehensive Survey of Living Conditions (CSLC) in 2022 on the functional limitations defined by the Washington Group Short Set may bridge the knowledge gap, with evaluation of the generalizability of the knowledge as CSLC2022 was conducted in the aftermath of the COVID-19 pandemic. We described the number and types of functional limitations among people with disabilities who did not participate in the general health examination and cancer screenings. For the generalizability evaluation, we analyzed preventive service uptake and its relevance to disability status and compared them with compatible data from the CSLC from 2016, conducted before the pandemic. Among the eligible data, the percentage of people with disabilities among the preventive healthcare service non-participants was 2.40-3.66% (n = 129-239); one-third had two or more types of functional limitations. Functional limitations in mobility and self-care (basic activities of daily living [BADL]) are common and dominant issues. No obvious difference was observed regarding the aforementioned statistics between CSLC2022 and CSLC2016. Reasonable accommodation for people with BADL related to uni- or multifunctional limitations may contribute to increased accessibility to preventive healthcare services.

Virtual Health Care Encounters for Lung Cancer Screening in a Safety-Net Population: Observations From the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic disrupted normal mechanisms of health care delivery and facilitated the rapid and widespread implementation of telehealth technology. As a result, the effectiveness of virtual health care visits in diverse populations represents an important consideration. We used lung cancer screening as a prototype to determine whether subsequent adherence differs between virtual and in-person encounters in an urban, safety-net health care system.

METHODS

We conducted a retrospective analysis of initial low-dose computed tomography (LDCT) ordered for lung cancer screening from March 2020 through February 2023 within Parkland Health, the integrated safety-net provider for Dallas County, TX. We collected data on patient characteristics, visit type, and LDCT completion from the electronic medical record. Associations among these variables were assessed using the chi-square test. We also performed interaction analyses according to visit type.

RESULTS

Initial LDCT orders were placed for a total of 1,887 patients, of whom 43% were female, 45% were Black, and 17% were Hispanic. Among these orders, 343 (18%) were placed during virtual health care visits. From March to August 2020, 79 of 163 (48%) LDCT orders were placed during virtual visits; after that time, 264 of 1,724 (15%) LDCT orders were placed during virtual visits. No patient characteristics were significantly associated with visit type (in-person v virtual) or LDCT completion. Rates of LDCT completion were 95% after in-person visits and 97% after virtual visits (P = .13).

CONCLUSION

In a safety-net lung cancer screening population, patients were as likely to complete postvisit initial LDCT when ordered in a virtual encounter as in an in-person encounter.

Association between health insurance coverage and stage of diagnosis for cervical cancer among females in Indiana from 2011 - 2019

Introduction

Health insurance status is an important determinant of health outcomes for patients with cancer. This study aimed to assess the extent to which health insurance coverage in Indiana is a contributing factor to the stage of cervical cancer diagnosis.

Methods

We examined reported cervical cancer cases among females (N = 2518) using cancer registry data from the Indiana Department of Health from 2011 to 2019. Analyses were carried out in SPSS. Using multinomial logistic regression, we examined associations of both insurance status and race/ethnicity with stage of diagnosis after adjusting for age at diagnosis.

Results

The multinomial analysis showed that uninsured females (OR = 2.42, 95 % CI = 1.35-4.35) and those who have Medicaid (OR = 2.36, 95 % CI = 1.62-3.42) were significantly more likely to be diagnosed at the regional stage than the in-situ stage compared to females with private insurance. Additionally, Black (OR = 1.98, 95 % CI = 1.21-3.24) and Hispanic females (OR = 2.19, 95 %CI = 1.04-4.61) were significantly more likely to be diagnosed at the regional stage than the in-situ stage when compared to Non-Hispanic White females. Females who are uninsured (OR = 4.43, 95 % CI = 2.23-8.44) and those who have Medicaid (OR = 3.03, 95 % CI = 1.91-4.80) were significantly more likely to be diagnosed at the distant stage than in-situ, compared to females with private insurance.

Conclusion

Insurance status and race/ethnicity are associated with later stages of cervical cancer diagnosis. Increased coverage for routine cervical cancer screening and preventive care services is recommended, especially for racial/ethnic minority populations, the uninsured and those with public insurance.

Clinician Response to the 2021 USPSTF Recommendation for Colorectal Cancer Screening in Average Risk Adults Aged 45-49 Years

INTRODUCTION

In 2021, the USPSTF lowered the recommended age of colorectal cancer (CRC) screening initiation from 50 to 45 years. This study assessed clinician response to the updated guideline in a major health system.

METHODS

This was a retrospective cohort study of average-risk, CRC screening-naïve adults aged 45-50 years with a primary care appointment between July 2018 and February 2023. The authors defined the pre-guideline change period as July 2018-February 2020 (pre-period) and the post-guideline change period as July 2021-February 2023 (post-period). Clinician ordering of any CRC screening type was assessed. Mixed effects Poisson regression was used to model the incidence rate ratio (IRR) of a patient receiving a screening order, including an interaction between age (45-49 years versus 50 years) and time period (pre- versus post-guideline change.) Variation in screening orders were also described by calendar quarter and clinician.

RESULTS

There were 28,114 patients in the pre-period and 22,509 in the post-period. Compared to patients aged 40-49 years in the pre-period, those in the post-period were more likely to have screening ordered (IRR=12.1; 95% CI=11.3-13.0). The screening ordering rate increased for patients aged 50 years from the pre- to the post-period (IRR=1.08; 95% CI=1.01, 1.16) and was slightly higher than that of patients aged 45-49 years in the post-period (IRR=1.08; 95% CI=1.02, 1.14). All clinicians increased their ordering rate for patients aged 45-49 years. Within 5 months of the guideline change, the ordering rate for patients aged 45-49 years and 50 years was nearly the same.

CONCLUSIONS

Rapidly following the guideline change, clinicians increased their screening ordering rate for patients aged 45-49 years, indicating almost complete uptake of the recommendation.

Predictors of Colorectal Cancer Screening and Screening Modalities among Patients seen at Federally Qualified Health Centers Funded by the United States Health Resources and Services Administration

Introduction

Federally qualified health centers provide primary care services to millions of low-income patients in the United States who face challenges accessing colorectal cancer (CRC) screening. We aimed to understand how patient-level factors influence CRC screening participation and screening modality choice in this setting.

Methods

We examined data from the 2022 Health Center Patient Survey, 2021 Uniform Data System, and Area Health Resource File. We performed generalized multilevel logistic regression and multinomial regression to measure associations between our independent variables and receipt of any CRC screening and of screening modalities.

Results

Among 1584 patients ages 50-75, most (56 %) reported having CRC screening, including 33 % with endoscopic screening only, 16 % with stool-based screening only, and 7 % with multiple modalities. Selected factors associated with any CRC screening included having five or more health center visits in the past year (aOR = 1.66, 95 %CI = 1.07-2.56), being insured (Medicaid aOR = 2.25, 95 %CI = 1.44-3.54; other insurance aOR = 2.69, 95 %CI = 1.51-4.82), living within 30  minutes of the health center (aOR = 1.93, 95 %CI = 1.15-3.25), having multiple comorbidities (aOR = 1.72, 95 %CI = 1.13-2.63), using telehealth (aOR = 1.52, 95 %CI = 1.02-2.27), and having a flu shot last year (aOR = 1.77, 95 %CI = 1.29-2.45). We observed that patients who are non-Hispanic Black (aOR = 3.52, 95 %CI = 1.28-9.68) and who do not speak English well or at all (aOR = 5.54, 95 %CI = 1.64-18.75) reported having multiple modalities.

Conclusion

Federally qualified health center patients reported endoscopic CRC screening more commonly than stool-based screening, and barriers to access such as distance to the health center and English proficiency were impactful. Increasing CRC screening in low-income populations requires improving access and promoting opportunities for less invasive screening.

Changes in Breast Cancer Screening Prevalence in the United States during the COVID-19 Pandemic, 2018 to 2022

BACKGROUND

Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared with 2018 in the national prevalence of self-reported up-to-date mammography.

METHODS

Using 2018 to 2022 data from the Center for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (biannual mammography in women of ages 50-74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics.

RESULTS

UTD breast cancer screening declined for the first time since 2018 [2018 compared with 2022, from 78.7%-76.6%; aPR, 0.97; 95% confidence interval (CI), 0.96-0.98] despite a small increase in past-year breast cancer screening from 2020 to 2022 (57.9%-59.6%; aPR, 1.03; 95% CI, 1.01-1.05). This translated to 747,791 fewer women reporting UTD with recommended breast cancer screening in 2022 versus 2018. UTD breast cancer screening declines between 2018 and 2022 were largest for American Indian/Alaska Native women (74.8%-62.2%; aPR, 0.83; 95% CI, 0.74-0.93), women with less formal educational attainment (< high school: 73.1%-65.5%; aPR, 0.9; 95% CI, 0.85-0.95), and women without a usual source of care (48%-42.9%; aPR, 0.85; 95% CI, 0.78-0.92).

CONCLUSIONS

Previously noted pandemic-related declines in past-year breast cancer screening now reflect in women reporting being UTD, with the largest declines in American Indian/Alaska Native women and those with lower socioeconomic status.

IMPACT

Future studies should monitor screening prevalence in relation to breast cancer diagnostic stage overall and by sociodemographic groups.

A Mail-Based HPV Self-Collection Program to Increase Cervical Cancer Screening in Appalachia: Results of a Group Randomized Trial

BACKGROUND

Despite the promise of mail-based human papillomavirus (HPV) self-collection programs for increasing cervical cancer screening, few have been evaluated in the United States. We report the results of a mail-based HPV self-collection program for underscreened women living in Appalachia.

METHODS

We conducted a group randomized trial from 2021 to 2022 in the Appalachian regions of Kentucky, Ohio, Virginia, and West Virgnia. Participants were women of ages 30 to 64 years who were underscreened for cervical cancer and from a participating health system. Participants in the intervention group (n = 464) were mailed an HPV self-collection kit followed by telephone-based patient navigation (if needed), and participants in the usual care group (n = 338) were mailed a reminder letter to get a clinic-based cervical cancer screening test. Generalized linear mixed models compared cervical cancer screening between the study groups.

RESULTS

Overall, 14.9% of participants in the intervention group and 5.0% of participants in the usual care group were screened for cervical cancer. The mail-based HPV self-collection intervention increased cervical cancer screening compared with the usual care group (OR, 3.30; 95% confidence interval, 1.90-5.72; P = 0.005). One or more high-risk HPV types were detected in 10.5% of the returned HPV self-collection kits. Among the participants in the intervention group whom patient navigators attempted to contact, 44.2% were successfully reached.

CONCLUSIONS

HPV self-collection increased cervical cancer screening, and future efforts are needed to determine how to optimize such programs, including the delivery of patient navigation services.

IMPACT

Mail-based HPV self-collection programs are a viable strategy for increasing cervical cancer screening among underscreened women living in Appalachia.

Disparities in Cancer Stage Shifts Associated with the COVID-19 Pandemic in California, 2020 to 2021

BACKGROUND

The COVID-19 pandemic and associated shutdowns disrupted healthcare access and resulted in decreased cancer screenings. Cancer diagnosis delays have concerning downstream effects on late-stage cancer, especially for marginalized populations.

METHODS

The study population included 349,458 adults in the California Cancer Registry diagnosed with cancer between January 2019 and December 2021, during which California experienced two stay-at-home orders. We examined the percentage of late-stage (III-IV) cancer diagnoses across five periods: Pre-pandemic (January 2019-February 2020), Shutdown #1 (March-June 2020), Post-shutdown #1 (July-November 2020), Post-shutdown #2 (December 2020-March 2021), and Post-vaccine rollout (April-December 2021). To examine the association between time period and late-stage diagnoses, we conducted a multivariable log-binomial regression model adjusted for sociodemographic and neighborhood factors.

RESULTS

The percentage of late-stage cancer diagnoses increased during Shutdown #1 (+5.2%) and returned to baseline Post-vaccine rollout. Groups with notably higher increases in the percentage of late-stage cancer (vs. overall population) during Shutdown #1 include Pacific Islander (+13.7%), Thai (+11.2%), Chinese (+8.1%), Native Hawaiian (+7.4%), Filipino (+6.6%), and uninsured (+7.4%). Uninsured [vs. private insurance; prevalence ratio (PR), 1.41], low neighborhood socioeconomic status (nSES; vs. high; PR, 1.19), and racial and ethnic minoritized groups (vs. non-Hispanic White; PR, 1.04-1.19) had higher likelihood for late-stage cancer diagnosis.

CONCLUSIONS

The pandemic exacerbated late-stage cancer disparities for racial and ethnic minoritized groups, underinsured, and low nSES communities in California (2020-2021).

IMPACT

Interventions to improve cancer screening must be focused on racial and ethnic minoritized, underinsured, and low nSES communities, as they are likely to be more vulnerable to healthcare disruptions like the pandemic.

Assessing impact of a community-based screening campaign to address social determinants of cervical cancer

BACKGROUND

Screening represents a cornerstone of cervical cancer control strategy. However, disparities in social determinants of health have perpetuated gaps in screening among racial and ethnic minorities. Social determinants of health including cultural stigma and lack of insurance have contributed to decreased screening among Hispanic women. To increase cancer screening in this population, community-academic partnerships and culturally tailored media have emerged as promising strategies.

METHODS

This study assessed the impact of a culturally tailored cervical cancer screening campaign implemented through academic-community-government partnerships. Intercept surveys, conducted from 2015 to 2018 in eastern neighborhoods of Los Angeles, assessed campaign recall, interpretation, and screening intention among Hispanic women aged 21-65 years after exposure to the campaign. Screening intention was evaluated using χ2 and logistic regression by participant characteristics, with thematic analysis for campaign interpretation.

RESULTS

Of 673 participants, 26.1% were uninsured, and 85.9% primarily spoke Spanish at home. Campaign recall was 25.1%, with 64.5% interpreting the campaign's message as cervical cancer screening or health checkups. The campaign's most liked aspect was emphasis on family (cited by 37.1% of participants). Postcampaign, 89.5% of participants overall were likely or extremely likely to schedule a Pap test, including 83.5% of women who had not had a Pap test in the past 3 years.

CONCLUSIONS

Our findings underscore several important strategies to reduce cervical cancer disparities: (1) associating positive cultural values with screening to decrease stigma, (2) combining culturally tailored outreach with interventions that target other known screening barriers, (3) facilitating long-term community relationships, and (4) leveraging academic-community-government partnerships.

Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020

OBJECTIVE

Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic.

METHODS

From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening.

RESULTS

Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9).

CONCLUSION

The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

A Cohort Study of Lt. Col. Luke J. Weathers VA Medical Center Patients with Positive FIT and Incomplete GI Evaluation during the COVID-19 Pandemic

OBJECTIVES

The reasons for and incidence of delay in screening colonoscopies during the coronavirus disease 2019 (COVID-19) pandemic are of major public health interest. The risks and reasons for delay likely vary between public and private institutions. This research sought to analyze data regarding the completion of screening colonoscopies after a positive fecal immunochemical test (FIT) before and during the COVID-19 pandemic and the reasons for a delay in obtaining these results at the Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center. The goals were to evaluate the institutional resilience and analyze the problems associated with this major healthcare crisis.

METHODS

This closed cohort study included all positive FITs from our local Veterans Affairs (VA) medical center from October 2019 to January 2020 and July 2020 to May 2021. A total of 115 VA patients with a positive FIT prepandemic and 157 VA patients with a positive FIT during the pandemic were included. Completion rates within 180 days were measured, and charts were reviewed to identify the reasons for lack of completion. Both community and local VA procedures for veterans were included. Univariate and multivariable analyses were applied to calculate odds ratios (ORs). The Pearson χ2 test was applied to calculate P values.

RESULTS

VA patients' percentage of timely completion was lower pre-COVID-19 than it was during the pandemic, and the percentage of delayed completion was higher pre-COVID-19 than it was during the pandemic. Comparing patients who completed a colonoscopy with those who did not, increasing age had an OR of 0.947 (95% CI 0.920-0.975), and White race had an OR of 0.504 (95% CI 0.291-0.873). Evaluating delays in colonoscopy completion, VA colonoscopies versus referral to the community had an OR of 4.472 (95% CI 1.602-12.483), and pre-COVID-19 completion versus during COVID-19 had an OR of 4.663 (95% CI 1.727-12.594) with multivariable logistic regression.

CONCLUSIONS

There was a statistically significant increase in timely colonoscopy completion during the study period when compared with the pre-COVID-19 period. The completion rate was higher at the Lt. Col. Luke Weathers, Jr. VA Medical Center than a large population average in 2020, possibly related to community colonoscopies and an aggressive case management system. In addition, increasing age and White race were associated with decreased colonoscopy completion. Predictors of an increased delay in colonoscopy completion included a pre-COVID-19 positive FIT and colonoscopies performed within the VA rather than being referred to providers in the community. A common reason for delay in all of the groups was patients declining intervention and delay/lack of referral.

Breast cancer statistics 2024

This is the American Cancer Society's biennial update of statistics on breast cancer among women based on high-quality incidence and mortality data from the National Cancer Institute and the Centers for Disease Control and Prevention. Breast cancer incidence continued an upward trend, rising by 1% annually during 2012-2021, largely confined to localized-stage and hormone receptor-positive disease. A steeper increase in women younger than 50 years (1.4% annually) versus 50 years and older (0.7%) overall was only significant among White women. Asian American/Pacific Islander women had the fastest increase in both age groups (2.7% and 2.5% per year, respectively); consequently, young Asian American/Pacific Islander women had the second lowest rate in 2000 (57.4 per 100,000) but the highest rate in 2021 (86.3 per 100,000) alongside White women (86.4 per 100,000), surpassing Black women (81.5 per 100,000). In contrast, the overall breast cancer death rate continuously declined during 1989-2022 by 44% overall, translating to 517,900 fewer breast cancer deaths during this time. However, not all women have experienced this progress; mortality remained unchanged since 1990 in American Indian/Alaska Native women, and Black women have 38% higher mortality than White women despite 5% lower incidence. Although the Black-White disparity partly reflects more triple-negative cancers, Black women have the lowest survival for every breast cancer subtype and stage except localized disease, with which they are 10% less likely to be diagnosed than White women (58% vs. 68%), highlighting disadvantages in social determinants of health. Progress against breast cancer could be accelerated by mitigating racial, ethnic, and social disparities through improved clinical trial representation and access to high-quality screening and treatment.

Regional Impact of the COVID-19 Pandemic on Cancer Screening

Cancer screening is the most cost-effective prevention strategy that enables improved cancer morbidity and mortality rates. However, there was a significant decline in cancer screening during the COVID-19 pandemic worldwide. This study aimed to measure regional differences in cancer screening by comparing screening rates before and during COVID-19 and to examine factors explaining the regional difference in cancer screening. All variables including the differences in cancer screening rate before and during the COVID-19 pandemic were collected from 229 administrative subregions in South Korea and joined with each community in ArcGIS environment. Factors explaining regional difference in cancer screening were analyzed through descriptive statistics, correlation analysis, and interactive decision tree modeling. Cancer screening rates decreased in all regions during the COVID-19 pandemic in South Korea. The findings revealed that national health insurance premiums, the number of cancer screening facilities, livelihood benefit recipients, and the population aged 65+ could be classified as variables highly affecting the decrease in cancer screening rate. These findings highlight the efforts to appraise different barriers to cancer screening in each community. In addition, it is important to promote sustainable cancer screening strategies from regional perspectives based on regional vulnerabilities and their complex impact on cancer screening.

Hispanic individuals' cervical cancer screening disparities amidst the COVID-19 pandemic

OBJECTIVE

To examine the impact of the COVID-19 pandemic on cervical cancer screening rates of Hispanic individuals compared to non-Hispanic White (NHW) individuals in the United States, whether a responsive surge in catch-up screenings occurred as society adapted to pandemic changes, and to investigate the sociodemographic characteristics between the study populations.

METHODS

Using cross-sectional data from the All of Us Research Program, which incorporates electronic health record data and survey data from a demographically, geographically, and medically diverse participant group, we assessed the annual cervical cancer screening rates during 2019-2021 by race/ethnicity among eligible individuals ages 21-64.

RESULTS

Among 116,052 unique individuals (78,829 NHW and 37,223 Hispanic), Hispanic individuals had lower annual cervical cancer screening rates than NHWI across the three years studied. They experienced a more significant decrease in screening from 2019 to 2020 (39.27 %) compared to NHWIs (21.15 %) and less of a rebound increase in the following year, 2021 (10.33 % vs 13.83 %). Hispanic individuals aged 50-64 experienced the sharpest decline in screening rates (-43.01 % from 2019 to 2020). Hispanic individuals also experienced greater adverse social conditions, including lack of insurance or employment, lower educational attainment, and lower household income.

CONCLUSIONS

Hispanic individuals experienced a more significant decrease in cervical cancer screening rates with the onset of the COVID-19 pandemic compared with NHW individuals and did not experience a robust rebound in cervical cancer screening rates in 2021. As a result, the disparity in cervical cancer screening rates between NHW and Hispanic individuals considerably worsened with the COVID-19 pandemic.

Rural-urban disparities and trends in cancer screening: an analysis of Behavioral Risk Factor Surveillance System data (2018-2022)

BACKGROUND

Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancers. This analysis aimed to examine rural-urban differences in recent trends for being up-to-date with screenings for breast, cervical, and colorectal cancers.

METHODS

We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible adults in the United States. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year.

RESULTS

Prevalence of being up-to-date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer, which dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022, with the odds of up-to-date screening being 14% to 27% lower for rural populations than for urban populations. For colorectal and cervical cancers, the odds of being up-to-date with screenings were lower for rural populations in 2018 and 2020, but no statistically significant difference was observed in 2022 (colorectal screening odds ratio = 0.96, 95% CI = 0.90 to 1.02; cervical screening odds ratio = 0.97, 95% CI = 0.93 to 1.03).

CONCLUSION

There is a concerning trend of decreasing uptake of cancer screenings that will challenge future efforts in cancer prevention and control. There is a need to better understand the factors contributing to the decline in cancer screening update.

Recovery From COVID-19-Related Disruptions in Cancer Detection

Importance

The COVID-19 pandemic impacted the timely diagnosis of cancer, which persisted as the second leading cause of death in the US throughout the pandemic.

Objective

To evaluate the disruption and potential recovery in cancer detection during the first (2020) and second (2021) years of the COVID-19 pandemic.

Design, Setting, and Participants

This cross-sectional study involved an epidemiologic analysis of nationally representative, population-based cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Included patients were diagnosed with incident cancer from January 1, 2000, through December 31, 2021. The analysis was conducted in May 2024 using the April 2024 SEER data release, which includes incidence data through December 31, 2021.

Exposures

Diagnosis of cancer during the first 2 years of the COVID-19 pandemic (2020, 2021).

Main Outcomes and Measures

Difference between the expected and observed cancer incidence in 2020 compared with 2021, with additional analyses by demographic subgroups (sex, race and ethnicity, and age group) and community (county-level) characteristics.

Results

The analysis included 15 831 912 patients diagnosed with invasive cancer between 2000 and 2021, including 759 810 patients in 2020 and 825 645 in 2021. The median age was 65 years (IQR, 56-75 years), and 51.0% were male. The percentage difference between the expected and observed cancer incidence was -8.6% (95% CI, -9.1% to -8.1%) in 2020, with no significant difference in 2021 (-0.2%; 95% CI, -0.7% to 0.4%). These translated to a cumulative (2020-2021) deficit in observed vs expected cases of -127 931 (95% CI, -139 206 to -116 655). Subgroup analyses revealed that incidence rates remained substantially depressed from expected rates into 2021 for patients living in the most rural counties (-4.9%; 95% CI, -6.7% to -3.1%). The cancer sites with the largest cumulative deficit in observed vs expected cases included lung and bronchus (-24 940 cases; 95% CI, -28 936 to -20 944 cases), prostate (-14 104 cases; 95% CI, -27 472 to -736 cases), and melanoma (-10 274 cases; 95% CI, -12 825 to -7724 cases).

Conclusions and Relevance

This cross-sectional study of nationally representative registry data found that cancer incidence recovered meaningfully in 2021 following substantial disruptions in 2020. However, incidence rates need to recover further to address the substantial number of patients with undiagnosed cancer during the pandemic.

A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations

BACKGROUND

Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity.

METHODS

A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant.

RESULTS

Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals).

CONCLUSIONS

A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

A Brief Report of Lung Cancer Screening Utilization Before, During, and in the Later Stages of the COVID-19 Pandemic in the United States

Introduction

Although COVID-19 has affected health care and screening utilization, its impact on lung cancer screening (LCS) uptake remains unclear. Our study investigated LCS utilization and associated predictors among adults eligible for LCS before (2019), during (2020-2021), and at a later stage (2022) of COVID-19.

Methods

We used cross-sectional, nationally representative, population-based data from the Behavioral Risk Factor Surveillance System over 4 consecutive years: 2019 (n = 4484; weighted n = 1,559,37), 2020 (n = 1239; weighted n = 200,301), 2021 (n = 1673; weighted n = 668,359), and 2022 (n = 20,804; weighted n = 9,458,907). The outcome was self-reported LCS uptake (0 = did not have LCS in the past 12 mo and 1 = underwent LCS in the past 12 mo). We conducted weighted statistics and multivariable logistic regression.

Results

Overall, of 11,886,704 million individuals eligible for LCS, 2,129,900 received LCS in 4 years (2019-2022). National rates of LCS among individuals eligible for screening were 16.3% (95% confidence interval [CI]:14.4-18.5), 19.4% (95% CI:15.3-24.3), 18.3% (95% CI:15.6-21.3), and 18.1% (95% CI:17.1-19.2) in 2019, 2020, 2021, and 2022, respectively. Respondents reporting lung disease and cancer (other than lung cancer) history were more likely to receive LCS across all 4 years. During the pandemic (2020), Hispanic (versus White), and rural (versus urban) residents had lower odds of LCS utilization. In 2022, men had increased odds of reporting LCS use relative to women. No sex differences in LCS use were observed in previous years.

Conclusions

Our findings indicate consistently low LCS utilization (<20%) over 4 years. Nationwide efforts to boost LCS awareness and utilization are essential for mitigating the lung cancer burden in the United States.

Factors associated with non-adherence to dual-energy x-ray absorptiometry screening during the COVID-19 pandemic in an academic medical center

This study explored why some elderly females do not adhere to their bone density tests. It found that factors like age, race, marital status, insurance type, social vulnerability index, and vaccination status influence completion of these tests. Addressing these differences could improve the management of bone health in older adults.

PURPOSE

This study investigated factors influencing the cancellation of dual-energy x-ray absorptiometry (DXA) scans among females aged 65 and above during the COVID-19 pandemic.

METHODS

Utilizing a dataset of 19,066 females from 2021 to 2023, the research employed chi-squared tests and logistic regression analyses to examine demographic, socio-economic, and health-related determinants of DXA scan adherence.

RESULTS

Key findings revealed that younger seniors, White patients, married individuals, those with commercial/private or Medicare insurance, and vaccinated persons were more likely to complete DXA scans. In contrast, Asian and African American females, along with those from higher Social Vulnerability Index areas, showed lower completion rates.

CONCLUSION

These results highlight the need for tailored strategies to improve osteoporosis screening adherence, focusing on identified demographic groups to enhance overall healthcare outcomes in osteoporosis management.

Reflections on the state of telehealth and cancer care research and future directions

Telemedicine has routinely been used in cancer care delivery for the past 3 years. The current state of digital health provides convenience and efficiency for both health-care professional and patient, but challenges exist in equitable access to virtual services. As increasingly newer technologies are added to telehealth platforms, it is essential to eliminate barriers to access through technical, procedural, and legislative improvements. Moving forward, implementation of new strategies can help eliminate disparities in virtual cancer care, facilitate delivery of treatment in the home, and improve real-time data collection for patient safety and clinical trial participation. The ultimate goal will be to extend high-quality survival for all patients with cancer through improved digital delivery of cancer care.

Impact of COVID-19 pandemic on breast cancer screening in a large midwestern United States academic medical center

BACKGROUND

Access to breast screening mammogram services decreased during the COVID-19 pandemic. Our objectives were to estimate: 1) the COVID-19 affected period, 2) the proportion of pandemic-associated missed or delayed screening encounters, and 3) pandemic-associated patient attrition in screening encounters overall and by sociodemographic subgroup.

METHODS

We included screening mammogram encounter EPIC data from 1-1-2019 to 12-31-2022 for females ≥40 years old. We used Bayesian State Space models to describe weekly screening mammogram counts, modeling an interruption that phased in and out between 3-1-2020 and 9-1-2020. We used the posterior predictive distribution to model differences between a predicted, uninterrupted process and the observed screening mammogram counts. We estimated associations between race/ethnicity and age group and return screening mammogram encounters during the pandemic among those with 2019 encounters using logistic regression.

RESULTS

Our analysis modeling weekly screening mammogram counts included 231,385 encounters (n = 127,621 women). Model-estimated screening mammograms dropped by >98% between 03-15-2020 and 05-24-2020 followed by a return to pre-pandemic levels or higher with similar results by race/ethnicity and age group. Among 79,257 women, non-Hispanic (NH) Asians, NH Blacks, and Hispanics had significantly (p < .05) lower odds of screening encounter returns during 2020-2022 vs. NH Whites with odds ratios (ORs) from 0.70 to 0.91. Among 79,983 women, those 60-69 had significantly higher odds of any return screening encounter during 2020-2022 (OR = 1.28), while those ≥80 and 40-49 had significantly lower odds (ORs 0.77, 0.45) than those 50-59 years old. A sensitivity analysis suggested a possible pre-existing pattern.

CONCLUSIONS

These data suggest a short-term pandemic effect on screening mammograms of ~2 months with no evidence of disparities. However, we observed racial/ethnic disparities in screening mammogram returns during the pandemic that may be at least partially pre-existing. These results may inform future pandemic planning and continued efforts to eliminate mammogram screening disparities.

Maximizing scarce colonoscopy resources: the crucial role of stool-based tests

During the COVID-19 pandemic, health systems, including federally qualified health centers, experienced disruptions in colorectal cancer (CRC) screening. National organizations called for greater use of at-home stool-based testing followed by colonoscopy for those with abnormal test results to limit (in-person) colonoscopy exams to people with acute symptoms or who were high risk. This stool-test-first strategy may also be useful for adults with low-risk adenomas who are due for surveillance colonoscopy. We argue that colonoscopy is overused as a first-line screening method in low- and average-risk adults and as a surveillance tool among adults with small adenomas. Yet, simultaneously, many people do not receive much-needed colonoscopies. Delivering the right screening tests at intervals that reduce the risk of CRC, while minimizing patient inconvenience and procedural risks, can strengthen health-care systems. Risk stratification could improve efficiency of CRC screening, but because models that adequately predict risk are years away from clinical use, we need to optimize use of currently available technology-that is, low-cost fecal testing followed by colonoscopy for those with abnormal test results. The COVID-19 pandemic highlighted the urgent need to adapt to resource constraints around colonoscopies and showed that increased use of stool-based testing was possible. Learning how to adapt to such constraints without sacrificing patients' health, particularly for patients who receive care at federally qualified health centers, should be a priority for CRC prevention research.

Breast Cancer Screening During the COVID-19 Pandemic in the United States: Results From Real-World Health Records Data

PURPOSE

The COVID-19 pandemic abruptly interrupted breast cancer screening, an essential preventive service in primary care. We aimed to evaluate the pandemic's impact on overall and follow-up breast cancer screening using real-world health records data.

METHODS

We retrospectively analyzed a cohort of women eligible for breast cancer screening through the study period from January 1, 2017 to February 28, 2022 using TriNetX Research Network data. We examined the temporal trend of monthly screening volume throughout the study period and compared the rate of adherence to follow-up screening within 24 months after the previous screening when the follow-up screening was due in the pre-COVID period vs the COVID period. To account for multiple screenings in the longitudinal data, we applied a logistic regression model using generalized estimating equations with adjustment for individual-level covariates.

RESULTS

Among 1,186,669 screening-eligible women, the monthly screening volume temporarily decreased by 80.6% from February to April 2020 and then rebounded to close to pre-COVID levels by June 2020. Yet, the follow-up screening rate decreased from 78.9% (95% CI, 78.8%-79.0%) in the pre-COVID period to 77.7% (95% CI, 77.6%-77.8%) in the COVID period. Multivariate regression analysis also showed a lower adherence to follow-up screening during the COVID period (odds ratio = 0.86; 0.86-0.87) and a greater pandemic impact among women aged 65 years and older and women of non-Hispanic "other" race (Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander).

CONCLUSIONS

The COVID-19 pandemic had a transient negative effect on breast cancer screening overall and a prolonged negative effect on follow-up screening. It also exacerbated gaps in adherence to follow-up screening, especially among certain vulnerable groups, requiring innovative strategies to address potential health disparities in primary care.

Long-term Mammography Screening Trends and Predictors of Return to Screening after the COVID-19 Pandemic: Results from a Statewide Registry

Purpose To evaluate long-term trends in mammography screening rates and identify sociodemographic and breast cancer risk characteristics associated with return to screening after the COVID-19 pandemic. Materials and Methods In this retrospective study, statewide screening mammography data of 222 384 female individuals aged 40 years or older (mean age, 58.8 years ± 11.7 [SD]) from the Vermont Breast Cancer Surveillance System were evaluated to generate descriptive statistics and Joinpoint models to characterize screening patterns during 2000-2022. Log-binomial regression models estimated associations of sociodemographic and risk characteristics with post-COVID-19 pandemic return to screening. Results The proportion of female individuals in Vermont aged 50-74 years with a screening mammogram obtained in the previous 2 years declined from a prepandemic level of 61.3% (95% CI: 61.1%, 61.6%) in 2019 to 56.0% (95% CI: 55.7%, 56.3%) in 2021 before rebounding to 60.7% (95% CI: 60.4%, 61.0%) in 2022. Screening adherence in 2022 remained substantially lower than that observed during the 2007-2010 apex of screening adherence (66.1%-67.0%). Joinpoint models estimated an annual percent change of -1.1% (95% CI: -1.5%, -0.8%) during 2010-2022. Among the cohort of 95 644 individuals screened during January 2018-March 2020, the probability of returning to screening during 2020-2022 varied by age (eg, risk ratio [RR] = 0.94 [95% CI: 0.93, 0.95] for age 40-44 vs age 60-64 years), race and ethnicity (RR = 0.84 [95% CI: 0.78, 0.90] for Black vs White individuals), education (RR = 0.84 [95% CI: 0.81, 0.86] for less than high school degree vs college degree), and by 5-year breast cancer risk (RR = 1.06 [95% CI: 1.04, 1.08] for very high vs average risk). Conclusion Despite a rebound to near prepandemic levels, Vermont mammography screening rates have steadily declined since 2010, with certain sociodemographic groups less likely to return to screening after the pandemic. Keywords: Mammography, Breast, Health Policy and Practice, Neoplasms-Primary, Epidemiology, Screening Supplemental material is available for this article. © RSNA, 2024.

Trends in breast, colon, pancreatic, and uterine cancers in women during the COVID-19 pandemic in North Carolina

IMPORTANCE

The COVID-19 pandemic led to reductions in primary care and cancer screening visits, which may delay detection of some cancers. The impact on incidence has not been fully quantified. We examined change in cancer incidence to determine how the COVID-19 pandemic may have altered the characteristics of cancers diagnosed among women.

METHODS

This study included female patients aged ≥18 years and diagnosed with breast (n = 9489), colon (n = 958), pancreatic (n = 669), or uterine (n = 1991) cancer at three hospitals in North Carolina. Using interrupted time series, we compared incidence of cancers diagnosed between March 2020 and November 2020 (during pandemic) with cancers diagnosed between January 2016 and February 2020 (pre-pandemic).

RESULTS

During the pandemic, incidence of breast and uterine cancers was significantly lower than expected compared to pre-pandemic (breast-18%, p = 0.03; uterine -20%, p = 0.05). Proportions of advanced pathologic stage and hormone receptor-negative breast cancers, and advanced clinical stage and large size uterine cancers were more prevalent during the pandemic. No significant changes in incidence were detected for pancreatic (-20%, p = 0.08) or colon (+14%, p = 0.30) cancers.

CONCLUSION AND RELEVANCE

In women, the COVID-19 pandemic resulted in a significant reduction in the incidence of breast and uterine cancers, but not colon or pancreatic cancers. A change in the proportion of poor prognosis breast and uterine cancers suggests that some cancers that otherwise would have been diagnosed at an earlier stage will be detected in later years. Continued analysis of long-term trends is needed to understand the full impact of the pandemic on cancer incidence and outcomes.

Limited English proficiency and reported receipt of colorectal cancer screening among adults 45-75 in 2019 and 2021

Introduction

Substantial barriers to screening exist for medically underserved populations, especially adults with limited English proficiency (LEP). We examined the proportion of US adults aged 45-75 up-to-date with colorectal cancer (CRC) screening by LEP after 2018. The American Cancer Society began recommending CRC screening for adults 45-49 in 2018.

Methods

We analyzed cross-sectional data of adults 45-75 years old participating in the 2019 or 2021 National Health Interview Survey (N = 25,611). Adults were considered up-to-date with screening if they reported any stool test within 1 year, stool-DNA testing within 3 years, or colonoscopy within 10 years. Adults who interviewed in a language other than English were considered to have LEP. Adults not up-to-date with screening were asked if a healthcare professional (HCP) recommended screening, and if so which test(s). Regression models conducted in 2022-2023 evaluated receipt of screening, adjusting for sociodemographics, year, and healthcare access.

Results

Overall, 54.0 % (95 % CI 53.1-54.9 %) of participants were up-to-date with screening (9.4 % aged 45-49 vs 75.5 % aged 65-75); prevalence increased from 2019 (52.9 %) to 2021(55.2 %). Adults with LEP (vs English proficiency) were less likely to be up-to-date with screening (31.6 % vs. 56.8 %, [aPR 0.86 (0.77-0.96)]). Among adults not up-to-date, 15.0 % reported their HCP recommended screening (8.4 % among adults with LEP).

Conclusions

Nearly half of US adults were not up-to-date with CRC screening in 2019 and 2021 and few reported being recommended screening. Adults with LEP and those 45-49 were least likely to be screened suggesting targeted interventions are needed for these populations.

Head and Neck Cancer Incidence in the United States Before and During the COVID-19 Pandemic

Importance

Research about population-level changes in the incidence and stage of head and neck cancer (HNC) associated with the COVID-19 pandemic is sparse.

Objective

To examine the change in localized vs advanced HNC incidence rates before and during the first year of the pandemic.

Design, Setting, and Participants

In this cross-sectional study of patients in the US diagnosed with HNC from 2017 to 2020, the estimated number with cancer of the oral cavity and pharynx (floor of mouth; gum and other mouth; lip; oropharynx and tonsil; and tongue) and larynx were identified from the SEER cancer registry. Subgroup analyses were stratified by race and ethnicity, age, and sex. Data were analyzed after the latest update in April 2023.

Exposure

The COVID-19 pandemic in 2020.

Main Outcomes and Measures

The primary outcomes were the annual incidence rates per 100 000 people for localized HNC (includes both localized and regional stages) and advanced HNC (distant stage) and weighted average annual percentage change from 2019 to 2020. Secondary outcomes included annual percentage change for 2017 to 2018 and 2018 to 2019, which provided context for comparison.

Results

An estimated 21 664 patients (15 341 [71%] male; 10 726 [50%] ≥65 years) were diagnosed with oral cavity and pharynx cancer in 2019 in the US, compared with 20 390 (4355 [70%] male; 10 393 [51%] ≥65 years) in 2020. Overall, the HNC incidence rate per 100 000 people declined from 11.6 cases in 2019 to 10.8 in 2020. The incidence rate of localized cancer declined to 8.8 cases (-7.9% [95% CI, -7.5 to -8.2]) from 2019 to 2020. The localized cancer incidence during the first year of the pandemic decreased the most among male patients (-9.3% [95% CI, -9.2 to -9.5]), Hispanic patients (-12.9% [95% CI, -12.9 to -13.0]), and individuals with larynx cancer (-14.3% [95% CI, -13.6 to -15.0]). No change in the overall incidence rate was found for advanced HNC.

Conclusions and Relevance

In this cross-sectional study, the incidence of localized HNC declined during the first year of the pandemic. A subsequent increase in advanced-stage diagnoses may be observed in later years.

Cancer screening in Japan 2 years after the COVID-19 pandemic: Changes in participation, 2017-2021

Objectives

The impact of the coronavirus disease (COVID-19) pandemic on cancer screening has become a global concern; compared with pre-pandemic levels, the number of individuals who underwent population-based cancer screening in Japan decreased by 10-30% in fiscal year (FY)2020. Therefore, it is important to monitor subsequent changes in the number of participants.

Methods

This descriptive study analysed data from a national database to determine changes from 2017 to 2021 in the number of people screened for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (faecal immunochemical test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear).

Results

Compared with the pre-pandemic period (FY 2017-2019), the number of participants in screening programmes in FY2021 decreased maximally for the gastric cancer UGI series (2.8 million to 2.2 million; -23.3 %), followed by those for lung cancer (7.9 million to 7.3 million; -8.2 %), colorectal cancer (8.4 million to 7.8 million; -7.3 %), breast cancer (3.1 million to 3.0 million; -4.5 %), and cervical cancer (4.3 million to 4.1 million; -3.2 %). Conversely, the number of people screened for endoscopic gastric cancer screening increased (1.0 million to 1.2 million; +13.1 %).

Conclusions

The number of participants, which decreased sharply immediately after the onset of the COVID-19 pandemic, recovered only slightly in FY2021 and did not return to pre-pandemic levels yet, except for endoscopic gastric cancer screening. Therefore, the impact of this decline in participation in cancer-detection programmes and changes in mortality should be monitored carefully.

Changes in cancer incidence rates by stage during the COVID-19 pandemic in the US

The coronavirus disease 2019 (COVID-19) pandemic led to health care disruptions and declines in cancer diagnoses in the United States. However, the impact of the pandemic on cancer incidence rates by stage at diagnosis and race and ethnicity is unknown. This cross-sectional study calculated delay- and age-adjusted incidence rates, stratified by stage at diagnosis and race and ethnicity, and rate ratios (RRs) comparing changes in year-over-year incidence rates (eg, 2020 vs 2019) from 2016 to 2020 for 22 cancer types based on data obtained from the Surveillance, Epidemiology, and End Results 22-registry database. From 2019 to 2020, the incidence of local-stage disease statistically significantly declined for 19 of the 22 cancer types, ranging from 4% (RR = 0.96; 95%CI, 0.93-0.98) for urinary bladder cancer to 18% for colorectal (RR = 0.82; 95%CI, 0.81-0.84) and laryngeal (RR = 0.82; 95%CI, 0.78-0.88) cancers, deviating from pre-COVID stable year-over-year changes. Incidence during the corresponding period also declined for 16 cancer types for regional-stage and six cancer types for distant-stage disease. By race and ethnicity, the decline in local-stage incidence for screening-detectable cancers was generally greater in historically marginalized populations. The decline in cancer incidence rates during the first year of the COVID-19 pandemic occurred mainly for local- and regional-stage diseases across racial and ethnic groups. Whether these declines will lead to increases in advanced-stage disease and mortality rates remain to be investigated with additional data years. Nevertheless, the findings reinforce the importance of strengthening the return to preventive care campaigns and outreach for detecting cancers at early and more treatable stages.

Unsatisfactory Fecal Immunochemical Tests for Colorectal Cancer Screening: Prevalence, Reasons, and Subsequent Testing

BACKGROUND

Fecal immunochemical test (FIT) is an effective colorectal cancer screening modality. Little is known about prevalence, reasons, and testing after unsatisfactory FIT, or a FIT that cannot be processed by the laboratory due to inadequate stool specimen or incomplete labeling.

METHODS

Our retrospective cohort study examined unsatisfactory FIT among average-risk individuals aged 50-74 years in a large, integrated, safety-net health system who completed an index FIT from 2010 to 2019. We determined prevalence of unsatisfactory FIT and categorized reasons hierarchically. We used multivariable logistic regression models to identify factors associated with: (i) unsatisfactory FIT; and (ii) subsequent testing within 15 months of the unsatisfactory FIT.

RESULTS

Of 56,980 individuals completing an index FIT, 10.2% had an unsatisfactory FIT. Reasons included inadequate specimen (51%), incomplete labeling (27%), old specimen (13%), and broken/leaking container (8%). Unsatisfactory FIT was associated with being male [OR, 1.10; confidence interval (CI), 1.03-1.16], Black (OR, 1.46; CI, 1.33-1.61), Spanish speaking (OR, 1.12; CI, 1.01-1.24), on Medicaid (OR, 1.42; CI, 1.28-1.58), and received FIT by mail (OR, 2.66; CI, 2.35-3.01). Among those with an unsatisfactory FIT, fewer than half (41%) completed a subsequent test within 15 months (median, 4.4 months). Adults aged 50-54 years (OR, 1.16; CI, 1.01-1.39) and those who received FIT by mail (OR, 1.92; CI, 1.49-2.09) were more likely to complete a subsequent test.

CONCLUSIONS

One in ten returned a FIT that could not be processed, mostly due to patient-related reasons. Fewer than half completed a subsequent test after unsatisfactory FIT.

IMPACT

Screening programs should address these breakdowns such as specimen collection and labeling to improve real-world effectiveness. See related In the Spotlight, p. 183.

Changes in Health Care Access and Preventive Health Screenings by Race and Ethnicity

Importance

The COVID-19 pandemic led to unprecedented disruptions in health care. Little is known about whether health care access and preventive health screenings among US adults have recovered to prepandemic levels, and how patterns varied by race and ethnicity.

Objective

To evaluate health care access and preventive health screenings among eligible US adults in 2021 and 2022 compared with prepandemic year 2019, overall and by race and ethnicity.

Design, Setting, and Participants

This cross-sectional study used data from US adults aged 18 years or older who participated in the National Health Interview Survey in 2021 and 2022. Survey weights provided by the National Health Interview Survey were used to generate nationally representative estimates. Data were analyzed from May 23 to November 13, 2023.

Main Outcomes and Measures

Measures of health care access included the proportion of adults with a usual place for care, those with a wellness visit, and those who delayed or did not receive medical care due to cost within the past year. Preventive health screening measures included eligible adults who received blood pressure, cholesterol, or blood glucose screening within the past year (2021), as well as colorectal, cervical, breast, and prostate cancer screenings based on US Preventive Services Task Force guidelines.

Results

The unweighted study population included 89 130 US adults. The weighted population included 51.6% females; 16.8% Hispanic, 5.9% non-Hispanic Asian (hereafter, Asian), 11.8% non-Hispanic Black (hereafter, Black), 62.8% non-Hispanic White (hereafter, White) individuals; and 2.9% individuals of other races and ethnicities (including American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, or multiracial). After adjusting for age and sex, having a usual place for health care did not differ among adults in 2021 or 2022 vs 2019 (adjusted rate ratio [ARR] for each year, 1.00; 95% CI, 0.99-1.01). However, fewer participants had wellness visits in 2022 compared with 2019 (ARR, 0.98; 95% CI, 0.97-0.99), with the most pronounced decline among Asian adults (ARR, 0.95; 95% CI, 0.92-0.98). In addition, adults were less likely to delay medical care (ARR, 0.79; 95% CI, 0.73-0.87) or to not receive care (ARR, 0.76; 95% CI, 0.69-0.83) due to cost in 2022 vs 2019. Preventive health screenings in 2021 remained below 2019 levels (blood pressure: ARR, 0.95 [95% CI, 0.94-0.96]; blood glucose: ARR, 0.95 [95% CI, 0.93-0.96]; and cholesterol: ARR, 0.93 [95% CI, 0.92-0.94]). Eligible adults were also significantly less likely to receive colorectal cancer screening (ARR, 0.88; 95% CI, 0.81-0.94), cervical cancer screening (ARR, 0.86; 95% CI, 0.83-0.89), breast cancer screening (ARR, 0.93; 95% CI, 0.90-0.97), and prostate cancer screening (ARR, 0.86 [0.78-0.94]) in 2021 vs 2019. Asian adults experienced the largest relative decreases across most preventive screenings, while Black and Hispanic adults experienced large declines in colorectal cancer screening (ARR, 0.78; 95% CI, 0.67-0.91) and breast cancer screening (ARR, 0.83; 95% CI, 0.75-0.91), respectively. Differences in preventive screening rates across years persisted after additional adjustment for socioeconomic factors (income, employment status, and insurance coverage).

Conclusions and Relevance

Results of this cohort study suggest that, in the US, wellness visits and preventive health screenings have not returned to prepandemic levels. These findings support the need for public health efforts to increase the use of preventive health screenings among eligible US adults.

Variation in Receipt of Cancer Screening and Immunizations by 10-year Life Expectancy among U.S. Adults aged 65 or Older in 2019

IMPORTANCE

The likelihood of benefit from a preventive intervention in an older adult depends on its time-to-benefit and the adult's life expectancy. For example, the time-to-benefit from cancer screening is >10 years, so adults with <10-year life expectancy are unlikely to benefit.

OBJECTIVE

To examine receipt of screening for breast, prostate, or colorectal cancer and receipt of immunizations by 10-year life expectancy.

DESIGN

Analysis of 2019 National Health Interview Survey.

PARTICIPANTS

8,329 non-institutionalized adults >65 years seen by a healthcare professional in the past year, representing 46.9 million US adults.

MAIN MEASURES

Proportions of breast, prostate, and colorectal cancer screenings, and immunizations, were stratified by 10-year life expectancy, estimated using a validated mortality index. We used logistic regression to examine receipt of cancer screening and immunizations by life expectancy and sociodemographic factors.

KEY RESULTS

Overall, 54.7% of participants were female, 41.4% were >75 years, and 76.4% were non-Hispanic White. Overall, 71.5% reported being current with colorectal cancer screening, including 61.4% of those with <10-year life expectancy. Among women, 67.0% reported a screening mammogram in the past 2 years, including 42.8% with <10-year life expectancy. Among men, 56.8% reported prostate specific antigen screening in the past two years, including 48.3% with <10-year life expectancy. Reported receipt of immunizations varied from 72.0% for influenza, 68.8% for pneumococcus, 57.7% for tetanus, and 42.6% for shingles vaccination. Lower life expectancy was associated with decreased likelihood of cancer screening and shingles vaccination but with increased likelihood of pneumococcal vaccination.

CONCLUSIONS

Despite the long time-to-benefit from cancer screening, in 2019 many US adults age >65 with <10-year life expectancy reported undergoing cancer screening while many did not receive immunizations with a shorter time-to-benefit. Interventions to improve individualization of preventive care based on older adults' life expectancy may improve care of older adults.

Changes in Prostate-specific Antigen Screening after the 2018 United States Preventive Services Task Force Recommendations and Through the COVID-19 Pandemic

We analyzed trends in prostate-specific antigen (PSA) screening for prostate cancer, with a focus on the impact of the 2018 US Preventive Services Task Force (USPSTF) recommendations and the COVID-19 outbreak. Using National Health Interview Survey data, we performed difference-in-difference (DID) analyses to examine the PSA screening trend for men aged 55-69 yr, the target population in the 2018 USPSTF update, with men aged >69 yr included as the reference and adjustment for sociodemographic factors. We found that PSA screening increased for men aged 55-69 yr (+4.6%, 95% confidence interval [CI] 1.7-7.5%) or >69 yr (+6.5%, 95% CI 2.7-10.4%) in 2019 (after the 2018 recommendations) in comparison to 2015. There was a decrease in PSA screening for men aged 55-69 yr in 2021 in comparison to 2019 (after the COVID-19 outbreak in 2020) of -3.1% (95%CI -0.4% to -5.8%). Adjusted DID analysis revealed no significant variations in the rate of change in PSA screening between the two age groups following both events. Despite its observational nature, our design mitigates major challenges in inferring causal relationships. Our results suggest a causal relationship between the 2018 screening guidelines and an increase in screening rates for men aged 55-69 yr. Conversely, they also indicate that preventive care disruptions related to COVID-19 may have induced deceleration or potentially reversal of these advances. PATIENT SUMMARY: We used data from a large national survey to study the rate of prostate-specific antigen (PSA) screening for prostate cancer in the USA in response to the 2018 United States Preventive Services Task Force recommendations and to the COVID-19 pandemic. We found an increase in PSA screening in 2019 among men aged 55-69 yr, the target population in the 2018 recommendations, as well as men aged >69 yr. However, this increase was reduced after the COVID-19 outbreak. It remains to be seen how PSA screening continues to change as the world recovers from COVID-19.

Prostate cancer screening in African American men: a review of the evidence

BACKGROUND

Prostate cancer is the most diagnosed cancer in African American men, yet prostate cancer screening regimens in this group are poorly guided by existing evidence, given underrepresentation of African American men in prostate cancer screening trials. It is critical to optimize prostate cancer screening and early detection in this high-risk group because underdiagnosis may lead to later-stage cancers at diagnosis and higher mortality while overdiagnosis may lead to unnecessary treatment.

METHODS

We performed a review of the literature related to prostate cancer screening and early detection specific to African American men to summarize the existing evidence available to guide health-care practice.

RESULTS

Limited evidence from observational and modeling studies suggests that African American men should be screened for prostate cancer. Consideration should be given to initiating screening of African American men at younger ages (eg, 45-50 years) and at more frequent intervals relative to other racial groups in the United States. Screening intervals can be optimized by using a baseline prostate-specific antigen measurement in midlife. Finally, no evidence has indicated that African American men would benefit from screening beyond 75 years of age; in fact, this group may experience higher rates of overdiagnosis at older ages.

CONCLUSIONS

The evidence base for prostate cancer screening in African American men is limited by the lack of large, randomized studies. Our literature search supported the need for African American men to be screened for prostate cancer, for initiating screening at younger ages (45-50 years), and perhaps screening at more frequent intervals relative to men of other racial groups in the United States.

Assessment of Changes in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US

Importance

The COVID-19 pandemic led to disruptions in access to health care, including cancer care. The extent of changes in receipt of cancer treatment is unclear.

Objective

To evaluate changes in the absolute number, proportion, and cancer treatment modalities provided to patients with newly diagnosed cancer during 2020, the first year of the pandemic.

Design, Setting, and Participants

In this cohort study, adults aged 18 years and older diagnosed with any solid tumor between January 1, 2018, and December 31, 2020, were identified using the National Cancer Database. Data analysis was conducted from September 19, 2022, to July 28, 2023.

Exposure

First year of the COVID-19 pandemic.

Main Outcomes and Measures

The expected number of procedures for each treatment modality (surgery, radiotherapy, chemotherapy, immunotherapy, and hormonal therapy) in 2020 were calculated using historical data (January 1, 2018, to December 31, 2019) with the vector autoregressive method. The difference between expected and observed numbers was evaluated using a generalized estimating equation under assumptions of the Poisson distribution for count data. Changes in the proportion of different types of cancer treatments initiated in 2020 were evaluated using the additive outlier method.

Results

A total of 3 504 342 patients (1 214 918 in 2018, mean [SD] age, 64.6 [13.6] years; 1 235 584 in 2019, mean [SD] age, 64.8 [13.6] years; and 1 053 840 in 2020, mean [SD] age, 64.9 [13.6] years) were included. Compared with expected treatment from previous years' trends, there were approximately 98 000 fewer curative intent surgical procedures performed, 38 800 fewer chemotherapy regimens, 55 500 fewer radiotherapy regimens, 6800 fewer immunotherapy regimens, and 32 000 fewer hormonal therapies initiated in 2020. For most cancer sites and stages evaluated, there was no statistically significant change in the type of cancer treatment provided during the first year of the pandemic, the exception being a statistically significant decrease in the proportion of patients receiving breast-conserving surgery and radiotherapy with a simultaneous statistically significant increase in the proportion of patients undergoing mastectomy for treatment of stage I breast cancer during the first months of the pandemic.

Conclusions and Relevance

In this large national cohort study, a significant deficit was noted in the number of cancer treatments provided in the first year of the COVID-19 pandemic. Data indicated that this deficit in the number of cancer treatments provided was associated with decreases in the number of cancer diagnoses, not changes in treatment strategies.

US Cancer Detection Decreased Nearly 9 Percent During The First Year Of The COVID-19 Pandemic

We investigated the impact of the COVID-19 pandemic on cancer detection, using data from the Surveillance, Epidemiology, and End Results Program, which recently released data through the first year of the pandemic (2020). Across all cancer sites, cancer incidence fell by 8.7 percent. The most common cancers that experienced the largest disruptions were lung and bronchus, melanoma of the skin, and thyroid cancer.

Annual Report to the Nation on the Status of Cancer, part 2: Early assessment of the COVID-19 pandemic's impact on cancer diagnosis

BACKGROUND

With access to cancer care services limited because of coronavirus disease 2019 control measures, cancer diagnosis and treatment have been delayed. The authors explored changes in the counts of US incident cases by cancer type, age, sex, race, and disease stage in 2020.

METHODS

Data were extracted from selected US population-based cancer registries for diagnosis years 2015-2020 using first-submission data from the North American Association of Central Cancer Registries. After a quality assessment, the monthly numbers of newly diagnosed cancer cases were extracted for six cancer types: colorectal, female breast, lung, pancreas, prostate, and thyroid. The observed numbers of incident cancer cases in 2020 were compared with the estimated numbers by calculating observed-to-expected (O/E) ratios. The expected numbers of incident cases were extrapolated using Joinpoint trend models.

RESULTS

The authors report an O/E ratio <1.0 for major screening-eligible cancer sites, indicating fewer newly diagnosed cases than expected in 2020. The O/E ratios were lowest in April 2020. For every cancer site except pancreas, Asians/Pacific Islanders had the lowest O/E ratio of any race group. O/E ratios were lower for cases diagnosed at localized stages than for cases diagnosed at advanced stages.

CONCLUSIONS

The current analysis provides strong evidence for declines in cancer diagnoses, relative to the expected numbers, between March and May of 2020. The declines correlate with reductions in pathology reports and are greater for cases diagnosed at in situ and localized stage, triggering concerns about potential poor cancer outcomes in the coming years, especially in Asians/Pacific Islanders.

PLAIN LANGUAGE SUMMARY

To help control the spread of coronavirus disease 2019 (COVID-19), health care organizations suspended nonessential medical procedures, including preventive cancer screening, during early 2020. Many individuals canceled or postponed cancer screening, potentially delaying cancer diagnosis. This study examines the impact of the COVID-19 pandemic on the number of newly diagnosed cancer cases in 2020 using first-submission, population-based cancer registry database. The monthly numbers of newly diagnosed cancer cases in 2020 were compared with the expected numbers based on past trends for six cancer sites. April 2020 had the sharpest decrease in cases compared with previous years, most likely because of the COVID-19 pandemic.

Trends in Gastrointestinal Infections during the COVID-19 Pandemic and Concerns of Post-Pandemic Resurgence in Japan

The impact of the COVID-19 pandemic was very broad and substantial, affecting a variety of fields worldwide. In Japan, the infection began spreading in March 2020. At that time, the government alerted people to cancel overseas travel, and encouraged wearing of masks, handwashing, sanitizing and keeping social distance. We sought to determine how COVID-19 infections affected other infectious diseases by investigating the trends in seven gastrointestinal infections that are listed among the 77 important infectious diseases designated by the National Institute of Infectious Diseases. We compared seven gastrointestinal infectious diseases, namely cholera, bacterial dysentery, enterohemorrhagic Escherichia coli, typhoid fever, paratyphoid fever, amoebic dysentery, and giardiasis, in terms of numbers of new cases before the COVID-19 pandemic (2012-2019) and during the pandemic (2020-2022). During the COVID-19 pandemic period (2020-2022), the incidence of the seven infections decreased significantly (p < 0.05) compared with before the pandemic (2012-2019). The sharp and significant decline in incidence of these seven infections in Japan during the COVID-19 pandemic period (2020-2022) appears to be due to restrictions on overseas travel and strict anti-infection measures, such as self-quarantine and encouragement of handwashing and sanitizing. The number of new cases of gastrointestinal infections in Japan is expected to increase in 2024 as these measures lapse. It is important for physicians to continue to monitor trends in gastrointestinal infections and educate people about proper infection prevention.

Association of Preventive Care Attitudes and Beliefs with Colorectal Cancer Screening History among African American Patients of Community Health Centers

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer-related death among African Americans in the United States. However, when detected early, CRC is treatable and survival rates are high. CRC health disparities for African Americans compared with other groups may be due in part to lower screening adherence and later stage diagnosis. The objective of this research phase was to test predictors of ever having received CRC screening (i.e., self-report of lifetime receipt of CRC screening) using survey measures in the domains of healthcare communication, trust in doctors, CRC perceived susceptibility, CRC worry, negative cancer beliefs, CRC screening self-efficacy, and cultural constructs for CRC screening in a sample of African American community health center patients. The study recruited 115 African American patients between the ages of 45 to 64 years old from community health centers in north Florida to complete the baseline survey. Our results show significant differences in CRC screening history by age, marital status, level of mistrust of healthcare providers, and level of empowerment toward cancer screening. To increase CRC screening in this population, the study findings suggest development of intervention programs that focus on priority populations of younger, unmarried African Americans, especially given the current trend of early onset CRC. Moreover, survival rates are lower for unmarried and younger African Americans relative to older and married individuals. Such interventions should also aim to increase trust in healthcare providers and increase empowerment for CRC screening decision making to increase screening participation.

Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021

INTRODUCTION

We examined national estimates of breast, cervical, and colorectal cancer (CRC) screening test use and compared them with Healthy People 2030 national targets. Test use in 2021 was compared with prepandemic estimates.

METHODS

In 2022, we used 2021 National Health Interview Survey (NHIS) data to estimate proportions of adults up to date with US Preventive Services Task Force recommendations for breast (women aged 50-74 y), cervical (women aged 21-65 y), and CRC screening (adults aged 50-75 y) across sociodemographic and health care access variables. We compared age-standardized estimates from the 2021 and 2019 NHIS.

RESULTS

Percentages of adults up to date in 2021 were 75.7% (95% CI, 74.4%-76.9%), 75.2% (95% CI, 73.9%-76.4%), and 72.2% (95% CI, 71.2%-73.2%) for breast, cervical, and CRC screening, respectively. Estimates were below 50% among those without a wellness check in 3 years (all screening types), among those without a usual source of care or insurance (aged <65 y) (breast and CRC screening), and among those residing in the US for less than 10 years (CRC screening). Percentages of adults who were up to date with breast and cervical cancer screening and colonoscopy were similar in 2019 and 2021. Fecal occult blood/fecal immunochemical test (FOBT/FIT) use was modestly higher in 2021 (P < .001).

CONCLUSIONS

In 2021, approximately 1 in 4 adults of screening age were not up to date with breast, cervical, and CRC screening recommendations, and Healthy People 2030 national targets were not met. Disparities existed across several characteristics, particularly those related to health care access. Breast, cervical, and colonoscopy test use within recommended screening intervals approximated prepandemic levels. FOBT/FIT estimates were modestly higher in 2021.