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Sprague BL, Nowak SA, Ahern TP, Herschorn SD, Kaufman PA, Odde C, Perry H, Sowden MM, Vacek PM, Weaver DL. Long-term Mammography Screening Trends and Predictors of Return to Screening after the COVID-19 Pandemic: Results from a Statewide Registry. Radiol Imaging Cancer 2024; 6:e230161. [PMID: 38578209 DOI: 10.1148/rycan.230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
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.
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Affiliation(s)
- Brian L Sprague
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sarah A Nowak
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Thomas P Ahern
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sally D Herschorn
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Peter A Kaufman
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Catherine Odde
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Hannah Perry
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Michelle M Sowden
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Pamela M Vacek
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Donald L Weaver
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
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Robertson DJ, Rex DK, Ciani O, Drummond MF. Colonoscopy vs the Fecal Immunochemical Test: Which is Best? Gastroenterology 2024; 166:758-771. [PMID: 38342196 DOI: 10.1053/j.gastro.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/13/2024]
Abstract
Although there is no debate around the effectiveness of colorectal cancer screening in reducing disease burden, there remains a question regarding the most effective and cost-effective screening modality. Current United States guidelines present a panel of options that include the 2 most commonly used modalities, colonoscopy and stool testing with the fecal immunochemical test (FIT). Large-scale comparative effectiveness trials comparing colonoscopy and FIT for colorectal cancer outcomes are underway, but results are not yet available. This review will separately state the "best case" for FIT and colonoscopy as the screening tool of first choice. In addition, the review will examine these modalities from a health economics perspective to provide the reader further context about the relative advantages of these commonly used tests.
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Affiliation(s)
- Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy
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Kratzer TB, Bandi P, Freedman ND, Smith RA, Travis WD, Jemal A, Siegel RL. Lung cancer statistics, 2023. Cancer 2024; 130:1330-1348. [PMID: 38279776 DOI: 10.1002/cncr.35128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 01/28/2024]
Abstract
Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2-year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant-stage disease incidence during 2013-2019, the rate for localized-stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%-5% annually) than in those with the lowest (by 1%-2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco-control efforts targeted at high-risk populations, including improved access to smoking-cessation treatments and lung cancer screening, as well as state-of-the-art treatment.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Neal D Freedman
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert A Smith
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - William D Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Coronado GD, Nyongesa DB, Petrik AF, Thompson JH, Escaron AL, Pham T, Leo MC. The Reach of Calls and Text Messages for Mailed FIT Outreach in the PROMPT Stepped-Wedge Colorectal Cancer Screening Trial. Cancer Epidemiol Biomarkers Prev 2024; 33:525-533. [PMID: 38319289 DOI: 10.1158/1055-9965.epi-23-0940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer screening participation. We assessed the reach and effectiveness of adding notifications to mailed FIT programs. METHODS We conducted secondary analyses of a stepped-wedge evaluation of an enhanced mailed FIT program (n = 15 clinics). Patients were stratified by prior FIT completion. Those with prior FIT were sent a text message (Group 1); those without were randomized 1:1 to receive a text message (Group 2) or live phone call (Group 3). All groups were sent automated phone call reminders. In stratified analysis, we measured reach and effectiveness (FIT completion within 6 months) and assessed patient-level associations using generalized estimating equations. RESULTS Patients (n = 16,934; 83% Latino; 72% completed prior FIT) were reached most often by text messages (78%), followed by live phone calls (71%), then automated phone calls (56%). FIT completion was higher in patients with prior FIT completion versus without [44% (Group 1) vs. 19% (Group 2 + Group 3); P < 0.01]. For patients without prior FIT, effectiveness was higher in those allocated to a live phone call [20% (Group 3) vs. 18% (Group 2) for text message; P = 0.04] and in those who personally answered the live call (28% vs. 9% no call completed; P < 0.01). CONCLUSIONS Text messages reached the most patients, yet effectiveness was highest in those who personally answered the live phone call. IMPACT Despite the broad reach and low cost of text messages, personalized approaches may more successfully boost FIT completion.
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Affiliation(s)
- Gloria D Coronado
- Kaiser Permanente Center for Health Research, Portland, Oregon
- University of Arizona Cancer Center, Tucson, Arizona
| | | | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Anne L Escaron
- AltaMed Health Services Corporation, Los Angeles, California
| | - Tuan Pham
- AltaMed Health Services Corporation, Los Angeles, California
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon
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Burus T, Lei F, Huang B, Christian WJ, Hull PC, Ellis AR, Slavova S, Tucker TC, Lang Kuhs KA. Undiagnosed Cancer Cases in the US During the First 10 Months of the COVID-19 Pandemic. JAMA Oncol 2024; 10:500-507. [PMID: 38386344 PMCID: PMC10884945 DOI: 10.1001/jamaoncol.2023.6969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 02/23/2024]
Abstract
Importance The COVID-19 pandemic disrupted the normal course of cancer screening and detection in the US. A nationwide analysis of the extent of this disruption using cancer registry data has not been conducted. Objective To assess the observed and expected cancer rate trends for March through December 2020 using data from all 50 US states and the District of Columbia. Design, Settings, and Participants This was a population-based cross-sectional analysis of cancer incidence trends using data on cases of invasive cancer diagnosis reported to the US Cancer Statistics from January 1, 2018, through December 31, 2020. Data analyses were performed from July 6 to 28, 2023. Exposure(s) Age, sex, race, urbanicity, and state-level response to the COVID-19 pandemic at the time of cancer diagnosis. Main Outcomes and Measures Used time-series forecasting methods to calculate expected cancer incidence rates for March 1 through December 31, 2020, from prepandemic trends (January 2018-February 2020). Measured relative difference between observed and expected cancer incidence rates and numbers of potentially missed cancer cases. Results This study included 1 297 874 cancer cases reported in the US from March 1 through December 31, 2020, with an age-adjusted incidence rate of 326.5 cases per 100 000 population. Of the observed cases, 657 743 (50.7%) occurred in male patients, 757 106 (58.3%) in persons 65 years or older, and 1 066 566 (82.2%) in White individuals. Observed rates of all-sites cancer incidence in the US were 28.6% (95% prediction interval [PI], 25.4%-31.7%) lower than expected during the height of the COVID-19 pandemic response (March-May 2020); 6.3% (95% PI, 3.8%-8.8%) lower in June to December 2020; and overall, 13.0% (95% PI, 11.2%-14.9%) lower during the first 10 months of the pandemic. These differences indicate that there were potentially 134 395 (95% PI, 112 544-156 680) undiagnosed cancers during that time frame. Prostate cancer accounted for the largest number of potentially missed cases (22 950), followed by female breast (16 870) and lung (16 333) cancers. Screenable cancers saw a total rate reduction of 13.9% (95% PI, 12.2%-15.6%) compared with the expected rate. The rate of female breast cancer showed evidence of recovery to previous trends after the first 3 months of the pandemic, but levels remained low for colorectal, cervical, and lung cancers. From March to May 2020, states with more restrictive COVID-19 responses had significantly greater disruptions, yet by December 2020, these differences were nonsignificant for all sites except lung, kidney, and pancreatic cancer. Conclusions and Relevance This cross-sectional analysis of cancer incidence trends found a substantial disruption to cancer diagnoses in the US during the first 10 months of the COVID-19 pandemic. The overall and differential findings can be used to inform where the US health care system should be looking to make up ground in cancer screening and detection.
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Affiliation(s)
- Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington
| | - Feitong Lei
- Markey Cancer Center, University of Kentucky, Lexington
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington
| | - W. Jay Christian
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Pamela C. Hull
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington
| | - Amanda R. Ellis
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
- Kentucky Injury Prevention & Research Center, University of Kentucky, Lexington
| | - Thomas C. Tucker
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Krystle A. Lang Kuhs
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
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Luce C, Palazzo L, Anderson ML, Carter-Bawa L, Gao H, Green BB, Ralston JD, Rogers K, Su YR, Tuzzio L, Triplette M, Wernli KJ. A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol. Contemp Clin Trials 2024; 140:107495. [PMID: 38467273 DOI: 10.1016/j.cct.2024.107495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/31/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND In real-world settings, low adherence to lung cancer screening (LCS) diminishes population-level benefits of reducing lung cancer mortality. We describe the Larch Study protocol, which tests the effectiveness of two patient-centered interventions (Patient Voices Video and Stepped Reminders) designed to address barriers and improve annual LCS adherence. METHODS The Larch Study is a pragmatic randomized clinical trial conducted within Kaiser Permanente Washington. Eligible patients (target n = 1606) are aged 50-78 years with an index low-dose CT (LDCT) of the chest with negative or benign findings. With a 2 × 2 factorial-design, patients are individually randomized to 1 of 4 arms: video only, reminders only, both video and reminders, or usual care. The Patient Voices video addresses patient education needs by normalizing LCS, reminding patients when LCS is due, and encouraging social support. Stepped Reminders prompts primary care physicians to order patient's repeat screening LDCT and patients to schedule their scan. Intervention delivery is embedded within routine healthcare, facilitated by shared electronic health record components. Primary outcome is adherence to national LCS clinical guidelines, defined as repeat LDCT within 9-15 months. Patient-reported outcomes are measured via survey (knowledge of LCS, perception of stigma) approximately 8 weeks after index LDCT. Our mixed-methods formative evaluation includes process data, collected during the trial, and interviews with trial participants and stakeholders. DISCUSSION Results will fill an important scientific gap on multilevel interventions to increase annual LCS adherence and provide opportunities for spread and scale to other healthcare settings. REGISTRATION Trial is registered at clinicaltrials.gov (#NCT05747443).
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Affiliation(s)
- Casey Luce
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Lisa Carter-Bawa
- Center for Discovery and Innovation at Hackensack Meridian Health, Nutley, NJ, USA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kristine Rogers
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA, USA
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Freeman HD, Saunders AC, Lum SS. COVID-19 Pandemic-Related Outcomes in High-Risk Gastrointestinal Cancers-Beyond the Numbers. JAMA Netw Open 2024; 7:e240143. [PMID: 38441901 DOI: 10.1001/jamanetworkopen.2024.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Hadley D Freeman
- Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, Loma Linda, California
| | - Aaron C Saunders
- Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, Loma Linda, California
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sharon S Lum
- Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, Loma Linda, California
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Hanuschak D, DePiero M, DeMoraes M, Bailly S, Rubens M, Lindeman P, Zinner M, Young G. The impact of COVID-19 on patients diagnosed with melanoma, breast, and colorectal cancer. Am J Surg 2024; 229:36-41. [PMID: 37798149 DOI: 10.1016/j.amjsurg.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted healthcare resource allocation and utilization of preventative medical services. It is unknown if there is resultant stage migration of melanoma, breast, and colorectal cancer when comparing extended time periods before and after the pandemic onset. METHODS A retrospective cohort study of melanoma, breast, and colorectal cancer patients was completed. Clinical and pathological staging was compared utilizing 12 and 22-month timeframes before and after the pandemic outbreak. RESULTS Between the 22-month pre- and post-COVID-19 groups, breast cancer clinical stage T2 significantly increased, and pathological stage 2 decreased. Colorectal cancer clinical stage T1 decreased, stage T4 increased, and stage 0 decreased in the 22-month groups. In the 12-month groups, melanoma clinical stage T1 increased, and colorectal cancer clinical stage N2 increased. CONCLUSIONS Evaluating extended timeframes beyond the immediate pre- and post-COVID-19 period revealed significant increases in clinical staging of breast and colorectal cancer, suggesting advanced disease is becoming more evident as time progresses.
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Affiliation(s)
- Danielle Hanuschak
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Mallori DePiero
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Melissa DeMoraes
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Shamoore Bailly
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Paul Lindeman
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Michael Zinner
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA; Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Geoffrey Young
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA; Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
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9
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Semprini J, Pagedar NA, Boakye EA, Osazuwa-Peters N. Head and Neck Cancer Incidence in the United States Before and During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg 2024; 150:193-200. [PMID: 38206603 PMCID: PMC10784997 DOI: 10.1001/jamaoto.2023.4322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024]
Abstract
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.
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Affiliation(s)
- Jason Semprini
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Nitin A Pagedar
- Department of Otolaryngology, University of Iowa Carver College of Medicine, Iowa City
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
- Department of Otolaryngology-Head & Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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10
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Schafer EJ, Islami F, Han X, Nogueira LM, Wagle NS, Yabroff KR, Sung H, Jemal A. Changes in cancer incidence rates by stage during the COVID-19 pandemic in the US. Int J Cancer 2024; 154:786-792. [PMID: 37971377 DOI: 10.1002/ijc.34758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 11/19/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth J Schafer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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11
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Howlader N, Bhattacharya M, Scoppa S, Miller D, Noone AM, Negoita S, Cronin K, Mariotto A. Cancer and COVID-19: US cancer incidence rates during the first year of the pandemic. J Natl Cancer Inst 2024; 116:208-215. [PMID: 37796818 PMCID: PMC10852612 DOI: 10.1093/jnci/djad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound global impact on health-care systems and patient outcomes. However, the specific effects of the pandemic on cancer incidence rates in the United States during its initial year remain unknown. METHODS In this study, we analyzed data from the Surveillance, Epidemiology, and End Results-22 registries, which encompass approximately 50% of the US population. We investigated changes in monthly incidence rates stratified by various factors, including cancer type, stage, age group, sex, race and ethnicity, socioeconomic status, rural-urban status, and registry locations. We compared the incidence rates observed during the pandemic with those from the previous year. RESULTS Our findings revealed a decline in incidence rates for all cancer sites combined starting in March 2020, coinciding with the implementation of stay-at-home orders. This decline reached its lowest point in April 2020 and persisted at a lower level until May 2020. Notably, compared with April 2019, the incidence rates in April 2020 dropped by 48.1% and did not consistently return to prepandemic levels. The reduction in cancer rates was more pronounced in urban and affluent counties. Across all cancer types, there was a statistically significant decrease in incidence rates during the pandemic, with the largest declines observed in thyroid (71.2%), prostate (57.9%), breast (54.9%), and colon and rectum cancers (54.1%). Furthermore, these decreases were primarily observed in early stage rather than late-stage disease. CONCLUSIONS The COVID-19 pandemic had a statistically significant impact on cancer outcomes. Monitoring long-term consequences of the pandemic on cancer incidence, stage at diagnosis, and mortality trends will be crucial.
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Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Manami Bhattacharya
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Steve Scoppa
- Information Management Services, Calverton, MD, USA
| | | | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Serban Negoita
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kathy Cronin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Angela Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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12
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Alba C, Zheng Z, Wadhera RK. Changes in Health Care Access and Preventive Health Screenings by Race and Ethnicity. JAMA Health Forum 2024; 5:e235058. [PMID: 38306093 PMCID: PMC10837752 DOI: 10.1001/jamahealthforum.2023.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
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.
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Affiliation(s)
- Christopher Alba
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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13
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Bak M, Chin CL, Chin J. Use of Health Belief Model-based Deep Learning to Understand Public Health Beliefs in Breast Cancer Screening from Social Media before and during the COVID-19 Pandemic. AMIA Annu Symp Proc 2024; 2023:280-288. [PMID: 38222395 PMCID: PMC10785880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Breast cancer is the second leading cause of cancer death for women in the United States. While breast cancer screening participation is the most effective method for early detection, screening rate has remained low. Given that understanding health perception is critical to understand health decisions, our study utilized the Health Belief Model-based deep learning method to predict and examine public health beliefs in breast cancer and its screening behavior. The results showed that the trends in public health perception are sensitive to political (i.e., changes in health policy), sociological (i.e., representation of disease and its preventive care by public figure or organization), psychological (i.e., social support), and environmental factors (i.e., COVID-19 pandemic). Our study explores the roles social media can play in public health surveillance and in public health promotion of preventive care.
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Affiliation(s)
- Michelle Bak
- University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Chieh-Li Chin
- University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Jessie Chin
- University of Illinois Urbana-Champaign, Champaign, IL, USA
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14
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Garg A, Galvin AM, Griner SB, Rosberger Z, Daley EM, Thompson EL. HPV self-sampling among women in the United States: preferences for implementation. Cancer Causes Control 2024; 35:167-176. [PMID: 37633857 DOI: 10.1007/s10552-023-01778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE With the inclusion of primary HPV testing in 2018 U.S. Preventive Services Taskforce guidelines, at-home HPV self-sampling may provide a future option for cervical cancer screening, especially among hard-to-reach populations in the U.S. This study evaluated the association of implementation preferences with the willingness of at-home HPV self-sampling. METHODS We conducted a cross-sectional study in 2018 among U.S. women ages 30-65 years, without a hysterectomy (n = 812). The outcome was willingness to have at-home HPV self-sampling (yes/no). Primary predictor variables (i.e., information source, methods of payment, methods of sending or receiving self-sampling kits) measured self-sampling implementation preferences. Adjusted logistic regression identified associations with willingness to have at-home HPV self-sampling. RESULTS Participants who preferred receiving information from healthcare providers (OR = 2.64; 95% CI 1.54,4.52) or from media or other sources (OR = 2.30; 95% CI 1.51,3.48) had higher HPV self-sampling willingness than participants who did not prefer those sources. Participants who did not want to pay for self-sampling (OR = 0.21; 95% CI 0.14,0.32) or did not know if they would pay for self-sampling (OR = 0.35; 95% CI 0.22,0.54) had lower odds of HPV self-sampling willingness compared to participants willing to pay. Participants who did not know which method they preferred for receiving a self-sampling kit (OR = 0.15, 95% CI 0.07,0.31) or preferred delivering the sample to the lab themselves (OR = 0.59; 95% CI 0.36,0.96) had lower odds for self-sampling willingness compared to participants who preferred the mail. CONCLUSION Understanding the preferences of women regarding the implementation of HPV self-sampling can improve uptake in cervical cancer screening, especially among hard-to-reach populations.
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Affiliation(s)
- Ashvita Garg
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stacey B Griner
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Zeev Rosberger
- Department of Oncology, Psychiatry and Psychology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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15
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Negoita S, Chen HS, Sanchez PV, Sherman RL, Henley SJ, Siegel R, Sung H, Scott S, Benard VB, Kohler BA, Jemal A, Cronin K. Annual Report to the Nation on the Status of Cancer, part 2: Early assessment of the COVID-19 pandemic's impact on cancer diagnosis. Cancer 2024; 130:117-127. [PMID: 37755665 PMCID: PMC10841454 DOI: 10.1002/cncr.35026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/14/2023] [Accepted: 08/11/2023] [Indexed: 09/28/2023]
Abstract
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.
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Affiliation(s)
- Serban Negoita
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Huann-Sheng Chen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Pamela V. Sanchez
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Recinda L. Sherman
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - S. Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Hyuna Sung
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Susan Scott
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Vicki B. Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Betsy A. Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kathleen Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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16
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Higurashi T, Tamura S, Misawa N, Horita N. Trends in Gastrointestinal Infections during the COVID-19 Pandemic and Concerns of Post-Pandemic Resurgence in Japan. Diseases 2023; 12:4. [PMID: 38275566 PMCID: PMC10813896 DOI: 10.3390/diseases12010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
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.
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Affiliation(s)
- Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan; (S.T.); (N.M.)
| | - Shigeki Tamura
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan; (S.T.); (N.M.)
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan; (S.T.); (N.M.)
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama 236-0004, Japan;
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17
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Wardell DW, Rozmus C, Pinner J. Energy Healers' Distance Healing Experience. J Holist Nurs 2023; 41:362-376. [PMID: 37165635 DOI: 10.1177/08980101231169884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to describe the experience of energy healing practitioners (specifically, Healing Touch) use of distance healing to provide insight into the methods, practice, and experience from the providers' perspective. One hundred and fifty-three energy workers participated in the open-ended survey. Overall, the experience of using distance healing during the pandemic was positive for practitioners in both giving and receiving. Practitioners also reported primarily positive feedback from their patients. A few respondents reported feeling hesitant about using distance healing and preferred hands-on work. However, distance healing was generally seen as providing flexibility to the practitioners' work, connection, and enhanced understanding of the human energy field.
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Affiliation(s)
| | - Cathy Rozmus
- The University of Texas Health Science Center at Houston, TX, USA
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18
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Lich KH, Mills SD, Kuo TM, Baggett CD, Wheeler SB. Multi-level predictors of being up-to-date with colorectal cancer screening. Cancer Causes Control 2023; 34:187-198. [PMID: 37285065 PMCID: PMC10244851 DOI: 10.1007/s10552-023-01723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Assessing factors associated with being up-to-date with colorectal cancer (CRC) screening is important for identifying populations for which targeted interventions may be needed. METHODS This study used Medicare and private insurance claims data for residents of North Carolina to identify up-to-date status in the 10th year of continuous enrollment in the claims data and in available subsequent years. USPSTF guidelines were used to define up-to-date status for multiple recommended modalities. Area Health Resources Files provided geographic and health care service provider data at the county level. A generalized estimating equation logistic regression model was used to examine the association between individual- and county-level characteristics and being up-to-date with CRC screening. RESULTS From 2012-2016, 75% of the sample (n = 274,660) age 59-75 was up-to-date. We identified several individual- (e.g., sex, age, insurance type, recent visit with a primary care provider, distance to nearest endoscopy facility, insurance type) and county-level (e.g., percentage of residents with a high school education, without insurance, and unemployed) predictors of being up-to-date. For example, individuals had higher odds of being up-to-date if they were age 73-75 as compared to age 59 [OR: 1.12 (1.09, 1.15)], and if living in counties with more primary care physicians [OR: 1.03 (1.01, 1.06)]. CONCLUSION This study identified 12 individual- and county-level demographic characteristics related to being up-to-date with screening to inform how interventions may optimally be targeted.
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Affiliation(s)
- Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavran-Greenberg Hall, Chapel Hill, NC, CB #7411, USA.
| | - Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavran-Greenberg Hall, Chapel Hill, NC, CB #7411, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Zaborski NL, Andridge RR, Paskett ED, Katz ML. Food insecurity among adult females with a history of breast cancer compared to adult females without cancer in the USA. J Cancer Surviv 2023:10.1007/s11764-023-01481-3. [PMID: 37932640 DOI: 10.1007/s11764-023-01481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To determine the prevalence of food insecurity (FI) among females with a history of breast cancer compared to females without cancer in the USA and the sociodemographic characteristics that may explain their FI. METHODS Using the 2019 National Health Interview (NHIS) survey that included the US Department of Agriculture's (USDA's) 10-item Household Food Security Survey Module, participants with high/moderate food security were considered food secure and low/very low food security were considered food insecure. Analyses accounted for complex survey design and included descriptive statistics, bivariate analyses, and multivariate regression analyses. RESULTS Eligible females (40+ years old) included 557 with a history of breast cancer and 9678 without a cancer history. FI was experienced by an estimated 4.4% of females with breast cancer, compared to 9.3% of females without cancer. Controlling for age, race/ethnicity, education level, general health status, and body mass index, the prevalence ratio between the two study groups was 0.50 (95% CI 0.33-0.78). CONCLUSIONS In this national sample, the prevalence of FI among females with a history breast cancer was lower than females without a history of cancer. IMPLICATIONS FOR CANCER SURVIVORS FI is low among breast cancer survivors, and routine FI screening among breast cancer survivors may not be warranted for all patients. Healthcare providers, however, should be aware of FI as a social determinant of health and consider it when there are known financial issues among cancer survivors.
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Affiliation(s)
- Natalie L Zaborski
- Division of Health Behavior and Health Promotion, College of Public Health, and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Rebecca R Andridge
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA.
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20
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Sabatino SA, Thompson TD, White MC, Villarroel MA, Shapiro JA, Croswell JM, Richardson LC. Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021. Prev Chronic Dis 2023; 20:E94. [PMID: 37884318 PMCID: PMC10625435 DOI: 10.5888/pcd20.230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
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.
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Affiliation(s)
- Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- 4770 Buford Hwy, Mailstop S107-4, Atlanta, GA 30341-3717
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary C White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria A Villarroel
- Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Jean A Shapiro
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Bose S, Basu P, Mandal R, Chakrabarti J, Vernekar M, Banerjee D, Chatterjee P, Ray C. A Study of the Impact and Restitutive Efforts of Cervical Cancer Screening during the COVID-19 Pandemic in a Regionsl Cancer Centre in Eastern India. Asian Pac J Cancer Prev 2023; 24:3495-3500. [PMID: 37898855 PMCID: PMC10770680 DOI: 10.31557/apjcp.2023.24.10.3495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/07/2023] [Indexed: 10/30/2023] Open
Abstract
AIM To evaluate the feasibility and efficacy of switching to a self-sampling based screening as compared to ongoing provider-collection based screening using HPV DNA test and assess the compliance of HPV positive women for further treatment during the COVID 19 pandemic. METHOD The study participants were women aged 30-60 years from rural and semi-urban communities around Kolkata, who underwent screening followed by HPV testing by Hybrid Capture II test. In the pre pandemic era, the women who attended the health centres where trained health workers that collected cervical samples. Following lockdown, the health workers distributed the self-sampling device to the women during home visits and counselled them to collect their samples by themselves. Thereafter the self collected screened positive women were brought to the hospital for further treatment instead of community clinics. RESULTS From April 2018 to March 2020, 12,718 women underwent screening using either HPV DNA test or visual inspection with acetic acid. HPV samples were either provider collected (62.7%) or self-collected (37.2%). The HPV positivity and CIN2+ detection rate were 5.4% and 2%. From April 2020 to February 2022, 10,792 women underwent screening using self-sampling only. The HPV positivity rate and CIN2+ detection rate were found to be 5.1% and 1.9 % . CONCLUSION Cervical cancer screening by HPV self-sampling advocates participation of more women especially in rural areas, while accelerating progress towards elimination of cervical cancer.
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Affiliation(s)
- Sreeya Bose
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (WHO), Lyon, France.
| | - Ranajit Mandal
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Jayanta Chakrabarti
- Department of Surgical Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Manisha Vernekar
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Dipanwita Banerjee
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Puja Chatterjee
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Chandrima Ray
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
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22
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Miller EA, Pinsky PF. Changes in uptake of stool-based colorectal cancer screening during the Covid-19 pandemic. Cancer Causes Control 2023; 34:887-895. [PMID: 37310565 DOI: 10.1007/s10552-023-01733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Colorectal cancer (CRC) screening is underutilized and endoscopic colon screening includes a number of barriers that were exacerbated by the Covid-19 pandemic. At-home stool-based screening (SBS) increased during the pandemic and potentially reached eligible adults hesitant to be screened by endoscopy. The purpose of this analysis was to examine the change in uptake of SBS during the pandemic among adults not screened within guidelines by endoscopy. METHODS We used data from the 2019 and 2021 National Health Interview Surveys to estimate uptake of SBS among adults aged 50-75 years, without a previous diagnosis of CRC and without guideline-concordant endoscopic screening. We also examined provider recommendations for screening tests. To examine if changes in uptake differed during the pandemic by demographic and health characteristics, we combined survey years and ran logistic regression models with an interaction term for each factor and survey year. RESULTS In our study population, SBS increased 74% overall from 2019 to 2021 (8.7% to 15.1%; p < 0.001), with the largest percent increase among those aged 50-52 years (3.5% to 9.9%; p < 0.001). Among those aged 50-52 years, the ratio of endoscopy to SBS changed from 83%/17% in 2019 to 55%/45% in 2021. Cologuard was the only screening test where recommendations by healthcare providers significantly increased from 2019 (10.6% to 16.1%; p = 0.002). CONCLUSIONS Use and recommendations for SBS increased substantially during the pandemic. Increased awareness among patients could potentially improve future CRC screening rates if uptake of SBS occurs among those unable or unwilling to be screened by endoscopy.
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Affiliation(s)
- Eric A Miller
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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23
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Inoue D, Orisaka M, Hirose H, Miyashita H, Yamada S, Tsuyoshi H, Shinagawa A, Kurokawa T, Yoshida Y. Attitudes toward cancer screening in regional Japan during the COVID-19 pandemic: An anonymous survey. Cancer Sci 2023; 114:4081-4088. [PMID: 37605505 PMCID: PMC10551611 DOI: 10.1111/cas.15931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has raised concerns about the impact of delayed health check-ups and cancer screenings on cancer diagnosis and treatment. This study aimed to investigate the awareness of cancer patients on future screening measures during the pandemic in rural Japan. An anonymized open-data survey was undertaken in Fukui Prefecture, a rural region of Japan, in 2021. Participants were asked about their cancer screening history, screening frequency during the pandemic, and reasons for not undergoing screening. Among the 1262 respondents, the proportion of patients who underwent cancer screening in 2020 during the pandemic was similar to the proportion who underwent regular (annual or biannual) screening in 2019 before the pandemic. Of those who underwent regular screening, 82% still underwent screening in 2020, while only 21% of those who had irregular screenings. The number of respondents who believed they were healthy and did not require screening increased over time, possibly due to restrictions on going out and refraining from activities during the pandemic. This study in rural Japan found that regular cancer screening prior to the pandemic was associated with a more positive attitude toward screening during the pandemic. Raising awareness about the importance of cancer screening and encouraging participation is crucial for promoting positive attitudes in the future. The findings highlight the need for continued efforts to ensure access to screening services during the pandemic and future public health emergencies.
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Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Makoto Orisaka
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Hiroaki Hirose
- Department of Health and WelfareFukui PrefectureFukuiJapan
| | | | - Shizuka Yamada
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Akiko Shinagawa
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Tetsuji Kurokawa
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Yoshio Yoshida
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
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24
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Gunn CM, Berrian K, Weiss JE, Tosteson AAN, Hasson RM, Di Florio-Alexander R, Peacock JL, Rees JR. A population-based survey of self-reported delays in breast, cervical, colorectal and lung cancer screening. Prev Med 2023; 175:107649. [PMID: 37517458 PMCID: PMC10763992 DOI: 10.1016/j.ypmed.2023.107649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
The early COVID-19 pandemic was associated with cessation of screening services, but the prevalence of ongoing delays in cancer screening into the third year of the pandemic are not well-characterized. In February/March 2022, a population-based survey assessed cancer needs in New Hampshire and Vermont. The associations between cancer screening delays (breast, cervical, colorectal or lung cancer) and social determinants of health, health care access, and cancer attitudes and beliefs were tested. Distributions and Rao-Scott chi-square tests were used for hypothesis testing and weighted to represent state populations. Of 1717 participants, 55% resided in rural areas, 96% identified as White race, 50% were women, 36% had high school or less education. Screening delays were reported for breast cancer (28%), cervical cancer (30%), colorectal cancer (24%), and lung cancer (30%). Delays were associated with having higher educational attainment (lung), urban living (colorectal), and having Medicaid insurance (breast, cervical). Low confidence in ability to obtain information about cancer was associated with screening delays across screening types. The most common reason for delay was the perception that the screening test was not urgent (31% breast, 30% cervical, 28% colorectal). Cost was the most common reason for delayed lung cancer screening (36%). COVID-19 was indicated as a delay reason in 15-29% of respondents; 12-20% reported health system capacity during the pandemic as a reason for delay, depending on screening type. Interventions that address sub-populations and reasons for screening delays are needed to mitigate the impact of the COVID-19 pandemic on cancer burden and mortality.
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Affiliation(s)
- Christine M Gunn
- The Dartmouth Cancer Center, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America.
| | - Kedryn Berrian
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Julie E Weiss
- The Dartmouth Cancer Center, Lebanon, NH, United States of America
| | - Anna A N Tosteson
- The Dartmouth Cancer Center, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Rian M Hasson
- The Dartmouth Cancer Center, Lebanon, NH, United States of America; Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States of America
| | - Roberta Di Florio-Alexander
- The Dartmouth Cancer Center, Lebanon, NH, United States of America; Department of Radiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Janet L Peacock
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States of America
| | - Judy R Rees
- The Dartmouth Cancer Center, Lebanon, NH, United States of America; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States of America
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25
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Ledford SG, Kessler F, Moss JL, Wang M, Lengerich EJ. The Impact of the COVID-19 Pandemic on Cancer Mortality in Pennsylvania: A Retrospective Study with Geospatial Analysis. Cancers (Basel) 2023; 15:4788. [PMID: 37835482 PMCID: PMC10571537 DOI: 10.3390/cancers15194788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/09/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND We sought to quantify the impact of the COVID-19 pandemic on cancer mortality and identify associated factors in Pennsylvania. METHODS The retrospective study analyzed cross-sectional cancer mortality data from CDC WONDER for 2015 through 2020 for Pennsylvania and its 67 counties. The spatial distributions of 2019, 2020, and percentage change in age-adjusted mortality rates by county were analyzed via choropleth maps and spatial autocorrelation. A Wilcoxon Signed Rank Test was used to analyze whether the rates differed between 2019 and 2020. Quasi-Poisson and geographically weighted regression at the county level were used to assess the association between the 2019 rates, sex (percent female), race (percent non-White), ethnicity (percent Hispanic/Latino), rural-urban continuum codes, and socioeconomic status with the 2020 rates. RESULTS At the state level, the rate in 2020 did not reflect the declining annual trend (-2.7 per 100,000) in the rate since 2015. Twenty-six counties had an increase in the rate in 2020. Of the factors examined, the 2019 rates were positively associated with the 2020 rates, and the impact of sociodemographic and geographic factors on the 2020 rates varied by county. CONCLUSIONS In Pennsylvania, the 2020 cancer mortality rates did not decline as much as reported before the COVID-19 pandemic. The top five cancer types by rate were the same type for 2019 and 2020. Future cancer control efforts may need to address the impact of the COVID-19 pandemic on trends and geospatial distribution in cancer mortality.
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Affiliation(s)
- Savanna G. Ledford
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA; (S.G.L.); (J.L.M.)
- Penn State Cancer Institute, Hershey, PA 17033, USA
| | - Fritz Kessler
- Department of Geography, College of Earth and Mineral Sciences, University Park, The Pennsylvania State University, State College, PA 16801, USA;
| | - Jennifer L. Moss
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA; (S.G.L.); (J.L.M.)
- Penn State Cancer Institute, Hershey, PA 17033, USA
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Eugene J. Lengerich
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA; (S.G.L.); (J.L.M.)
- Penn State Cancer Institute, Hershey, PA 17033, USA
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
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26
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Star J, Bandi P, Siegel RL, Han X, Minihan A, Smith RA, Jemal A. Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic. J Clin Oncol 2023; 41:4352-4359. [PMID: 36821800 PMCID: PMC10911528 DOI: 10.1200/jco.22.02170] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions. [Media: see text].
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Affiliation(s)
- Jessica Star
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Priti Bandi
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Rebecca L. Siegel
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Adair Minihan
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Robert A. Smith
- Early Cancer Detection Science Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
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27
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Fuzzell L, Lake P, Brownstein NC, Fontenot HB, Whitmer A, Michel A, McIntyre M, Rossi SL, Kajtezovic S, Vadaparampil ST, Perkins R. Examining the perceived impact of the COVID-19 pandemic on cervical cancer screening practices among clinicians practicing in Federally Qualified Health Centers: A mixed methods study. eLife 2023; 12:e86358. [PMID: 37664989 PMCID: PMC10476963 DOI: 10.7554/elife.86358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs). Methods Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic. Results A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women's health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement. Conclusions Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health SciencesCharlestonUnited States
| | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Sidika Kajtezovic
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
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28
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Kuzuu K, Misawa N, Ashikari K, Tamura S, Kato S, Hosono K, Yoneda M, Nonaka T, Matsushima S, Komatsu T, Nakajima A, Higurashi T. Changes in the Number of Gastrointestinal Cancers and Stage at Diagnosis with COVID-19 Pandemic in Japan: A Multicenter Cohort Study. Cancers (Basel) 2023; 15:4410. [PMID: 37686686 PMCID: PMC10487252 DOI: 10.3390/cancers15174410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/13/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
This retrospective cohort study compared the number of newly diagnosed patients, stage at diagnosis, and detection process of gastrointestinal cancers based on hospital-based cancer registry data at two tertiary Japanese hospitals. The pre-COVID-19 period was from January 2017 to February 2020, with phase 1 (midst of COVID-19 pandemic) from March to December 2020 and phase 2 (the transition period to the "new normal") from January to December 2021. Each month, the number of patients diagnosed with esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers were aggregated, classified by stage and detection process, and compared, including a total of 6453 patients. The number of colorectal Stage 0-II patients decreased significantly in phase 1 and increased in phase 2. The total number of colorectal cancer patients returned to pre-COVID-19 levels (mean monthly patients [SD]: 41.61 [6.81] vs. 36.00 [6.72] vs. 46.00 [11.32]). The number of patients with gastric cancer Stage I significantly decreased in phase 2 following phase 1. The number of gastric cancer patients decreased significantly from pre-COVID-19 levels (30.63 [6.62] vs. 22.40 [5.85] vs. 24.50 [4.15]). During phase 2, the number of patients diagnosed after screening with colorectal cancer increased significantly, whereas that with gastric cancer remained considerably lower. The number of Stage III colorectal and gastric cancer patients increased significantly from the pre-COVID-19 levels. Thus, gastric cancer may not be optimally screened during phases 1 and 2. There was a significant increase in patients with Stage III colorectal and gastric cancers from the pre-COVID-19 period; hence, the stage at diagnosis may have progressed.
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Affiliation(s)
- Kento Kuzuu
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Shigeki Tamura
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Takashi Nonaka
- National Hospital Organization Yokohama Medical Center, 3-60-2 Harazyuku, Totuka-ku, Yokohama 245-8575, Japan; (T.N.); (S.M.); (T.K.)
| | - Shozo Matsushima
- National Hospital Organization Yokohama Medical Center, 3-60-2 Harazyuku, Totuka-ku, Yokohama 245-8575, Japan; (T.N.); (S.M.); (T.K.)
| | - Tatsuji Komatsu
- National Hospital Organization Yokohama Medical Center, 3-60-2 Harazyuku, Totuka-ku, Yokohama 245-8575, Japan; (T.N.); (S.M.); (T.K.)
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (K.K.); (N.M.); (K.A.); (S.T.); (S.K.); (K.H.); (M.Y.); (A.N.)
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Munigala S, Schoenfeld AJ, Mani V, Banaag A, Umoh A, Coles CL, Koehlmoos TP. Disparities in the use of colorectal cancer screening in a universally insured population during the COVID-19 pandemic. Cancer Med 2023; 12:18201-18210. [PMID: 37644735 PMCID: PMC10524012 DOI: 10.1002/cam4.6400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Despite the known efficacy of colorectal cancer (CRC) screening, the rates of individuals undergoing such testing have remained lower than target thresholds, even prior to the healthcare disruptions associated with the COVID-19 pandemic. We evaluated the impact of the COVID-19 pandemic on CRC screening within a nationally representative US population and assessed disparities in screening across racial/ethnic groups and socioeconomic (SES) strata. METHODS We performed a retrospective cross-sectional study using all eligible TRICARE beneficiaries aged 45-64 years between FY 2018 and 2021. High-risk individuals, those with a previous or current CRC diagnosis, and/or a personal/family history of colonic polyps, were excluded. The pre-COVID-19 period (September 1, 2018-March 31, 2020) was compared to the COVID-19 period (April 1, 2020-September 30, 2021). Secondary analyses were performed, evaluating the interaction between the COVID-19 time period, race, and our proxy for socioeconomic status. RESULTS During the study period, we identified 1,749,688 eligible individuals. Following the onset of the COVID-19 pandemic, CRC screening overall decreased from 34% in the pre-pandemic period to 30% following the onset of the pandemic (p < 0.001). This finding persisted even after adjusting for confounders in multivariable analysis (odds ratio [OR] for the pandemic timeframe: 0.79; 95% CI: 0.27, 0.31; p < 0.001). In the setting of SES, in the pandemic period, the odds of individuals from both Senior Enlisted (OR: 0.55; 95% CI: 0.54, 0.56) and Junior Enlisted sponsor ranks (OR: 0.27; 95% CI: 0.25, 0.30) were diminished as compared to Senior Officers. CONCLUSIONS AND RELEVANCE We found a 21% reduction in the odds of CRC screening in the context of the COVID-19 pandemic. Reductions in colonoscopies and other types of screening tests were not offset by changes in the use of at-home tests such as Cologuard.
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Affiliation(s)
- Satish Munigala
- Center for Health Services ResearchUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.BethesdaMarylandUSA
| | - Andrew J. Schoenfeld
- Department of Orthopaedic Surgery and Center for Surgery and Public HealthBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Vivitha Mani
- Center for Health Services ResearchUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.BethesdaMarylandUSA
| | - Amanda Banaag
- Center for Health Services ResearchUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.BethesdaMarylandUSA
| | - Ada Umoh
- Center for Health Services ResearchUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.BethesdaMarylandUSA
| | - Christian L. Coles
- Center for Health Services ResearchUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.BethesdaMarylandUSA
| | - Tracey Perez Koehlmoos
- Center for Health Services ResearchUniformed Services University of the Health SciencesBethesdaMarylandUSA
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Romatoski KS, Chung SH, Kenzik K, Rasic G, Ng SC, Tseng JF, Sachs TE. Delay and Disparity in Observed vs Predicted Incidence Rate of Screenable Cancer During the COVID-19 Pandemic. J Am Coll Surg 2023; 237:420-430. [PMID: 37227063 DOI: 10.1097/xcs.0000000000000772] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in disruption of healthcare services, including cancer screenings, yet data on this are limited. We sought to compare observed and expected cancer incidence rates for screenable cancers, quantifying potential missed diagnoses. STUDY DESIGN Lung, female breast, and colorectal cancer patients from 2010 to 2020 in the National Cancer Database were standardized to calculate annual incidence rates per 100,000. A linear regression model of 2010 through 2019 incidence rates (pre-COVID) was used to calculate predicted 2020 incidence compared with observed incidence in 2020 (COVID) with subanalyses for age, sex, race, ethnicity, and geographic region. RESULTS In total, 1,707,395 lung, 2,200,505 breast, and 1,066,138 colorectal cancer patients were analyzed. After standardizing, the observed 2020 incidence was 66.888, 152.059, and 36.522 per 100,000 compared with the predicted 2020 incidence of 81.650, 178.124, and 44.837 per 100,000, resulting in an observed incidence decrease of -18.1%, -14.6%, and -18.6% for lung, breast, and colorectal cancer, respectively. The difference was amplified on subanalysis for lung (female, 65 or more years old, non-White, Hispanic, Northeastern and Western region), breast (65 or more years old, non-Black, Hispanic, Northeastern and Western region), and colorectal (male, less than 65 years old, non-White, Hispanic, and Western region) cancer patients. CONCLUSIONS The reported incidence of screenable cancers significantly decreased during the COVID-19 pandemic (2020), suggesting that many patients currently harbor undiagnosed cancers. In addition to the human toll, this will further burden the healthcare system and increase future healthcare costs. It is imperative that providers empower patients to schedule cancer screenings to flatten this pending oncologic wave.
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Affiliation(s)
- Kelsey S Romatoski
- From the Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Zahnd WE, Silverman AF, Self S, Hung P, Natafgi N, Adams SA, Merrell MA, Owens OL, Crouch EL, Eberth JM. The COVID-19 pandemic impact on independent and provider-based rural health clinics' operations and cancer prevention and screening provision in the United States. J Rural Health 2023; 39:765-771. [PMID: 36869430 DOI: 10.1111/jrh.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based). METHODS We administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type. RESULTS Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic. DISCUSSION The pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Allie F Silverman
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Stella Self
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Peiyin Hung
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nabil Natafgi
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Melinda A Merrell
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Otis L Owens
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth L Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Management and Policy, Dornsife College of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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He Y, Xu T, Fang J, Tong L, Gao W, Zhang Y, Wang Y, Xu Y, Shi S, Liu S, Jin L. Trends in colorectal cancer screening in the United States, 2012 to 2020. J Med Screen 2023; 30:125-133. [PMID: 37157812 DOI: 10.1177/09691413231174163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Despite recommendations to increase the uptake of colorectal cancer (CRC) screening, trends in CRC screening vary with sociodemographic status. We aimed to evaluate trends in CRC screening in the US population and subpopulations. METHODS A total of 1,082,924 participants aged 50 to 75 from five cycles (2012, 2014, 2016, 2018, and 2020) of the Behavioral Risk Factor Surveillance System were involved. Multivariable logistic regression models were performed to evaluate linear trends in CRC screening utilization from 2012 to 2018. Rao-Scott chi-square tests were used to assess the differences in CRC screening utilization between 2018 and 2020. RESULTS The estimated percentage reporting up-to-date with CRC screening increased significantly (P for trend <0.001), from 62.8% (95% CI, 62.4%-63.2%) in 2012 to 66.7% (95% CI, 66.3%-67.2%) in 2018 and 70.4% (95% CI, 69.8%-71.0%) in 2020, in accordance with 2008 US Preventive Services Task Force recommendations. Trends followed similar patterns in most subgroups, although with different magnitudes in several subgroups, primarily those underweight showed a stable percentage over time (P for trend = 0.170). In 2020, 72.4% of participants reported they were up to date with CRC screening, including the utilization of stool DNA tests and virtual colonoscopy. Colonoscopy was the most commonly used test in 2020 (64.5%), followed by FOBT (12.6%), stool DNA test (5.8%), sigmoidoscopy (3.8%), and virtual colonoscopy (2.7%). CONCLUSIONS In this nationally representative survey of the US population from 2012 through 2020, the percentage reporting up to date with CRC screening has increased, but not equally among all subgroups.
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Affiliation(s)
- Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Tong Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Li Tong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Wenhui Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yanfang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Shunyao Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Siyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
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Lin GA, Phillips KA, Fendrick AM. Reading the crystal ball: Primary care implications while awaiting outcomes for multi-cancer early detection tests. Healthc (Amst) 2023; 11:100705. [PMID: 37598614 PMCID: PMC10823541 DOI: 10.1016/j.hjdsi.2023.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Grace A Lin
- Division of General Internal Medicine, University of California, San Francisco, USA; Center for Translational and Policy Research on Precision Medicine, University of California, San Francisco, USA.
| | - Kathryn A Phillips
- Center for Translational and Policy Research on Precision Medicine, University of California, San Francisco, USA
| | - A Mark Fendrick
- Center for Value-Based Insurance Design, University of Michigan, USA
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Semprini J, Ranganathan R. The 2020 US cancer screening deficit and the timing of adults' most recent screen: a population-based cross-sectional study. Fam Med Community Health 2023; 11:e001893. [PMID: 37730268 PMCID: PMC10510914 DOI: 10.1136/fmch-2022-001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE In 2020, cancer screenings declined, resulting in a cancer screening deficit. The significance of this deficit, however, has yet to be quantified from a population health perspective. Our study addresses this evidence gap by examining how the pandemic changed the timing of American adults' most recent cancer screen. METHODOLOGY We obtained population-based, cancer screening data from the Behavioural Risk Factor Surveillance System (BRFSS) (2010, 2012, 2014, 2016, 2018, 2020). Mammograms, pap smears and colonoscopies were each specified as a variable of mutually exclusive categories to indicate the timing since the most recent screening (never, 0-1 years, 1-2 years, 3+ years). Our cross-sectional, quasi-experimental design restricts the sample to adults surveyed in January, February or March. We then leverage a quirk in the BRFSS implementation and consider adults surveyed in the second year of the 2020 survey wave as exposed to the COVID-19 pandemic. Respondents surveyed in January 2020-March 2020 were considered unexposed. To estimate the impact of exposure to the COVID-19 pandemic on the timing of recent cancer screenings, we constructed linear and logistic regression models which control for sociodemographic characteristics associated with screening patterns, and state fixed effects and temporal trend fixed effects to control for confounding. RESULTS In 2020, the cancer screening deficit was largely due to a 1 year delay among adults who receive annual screening, as the proportion of adults reporting a cancer screen in the past year declined by a nearly identical proportion of adults reporting their most recent cancer screen 1-2 years ago (3%-4% points). However, the relative change was higher for mammograms and pap smears (17%) than colonoscopies (4%). We also found some evidence that the proportion of women reporting never having completed a mammogram declined in 2020, but the mechanisms for this finding should be further explored with the release of future data. CONCLUSION Our estimates for the pandemic's effect on cancer screening rates are smaller than prior studies. Because we account for temporal trends, we believe prior studies overestimated the effect of the pandemic and underestimated the overall downward trend in cancer screenings across the country leading up to 2020.
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Affiliation(s)
- Jason Semprini
- Health Management & Policy, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Radhika Ranganathan
- Epidemiology/Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
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Huguet N, Danna M, Baron A, Hall J, Hodes T, O’Malley J, Holderness H, Marino M, DeVoe JE, Cohen DJ. Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers: Practice Changes and Recovery Strategies. Med Care 2023; 61:554-561. [PMID: 37310241 PMCID: PMC10319245 DOI: 10.1097/mlr.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic led to clinical practice changes, which affected cancer preventive care delivery. OBJECTIVES To investigate the impact of the coronavirus disease 2019 pandemic on the delivery of colorectal cancer (CRC) and cervical cancer (CVC) screenings. RESEARCH DESIGN Parallel mixed methods design using electronic health record data (extracted between January 2019 and July 2021). Study results focused on 3 pandemic-related periods: March-May 2020, June-October 2020, and November 2020-September 2021. SUBJECTS Two hundred seventeen community health centers located in 13 states and 29 semistructured interviews from 13 community health centers. MEASURES Monthly up-to-date CRC and CVC screening rates and monthly rates of completed colonoscopies, fecal immunochemical test (FIT)/fecal occult blood test (FOBT) procedures, Papanicolaou tests among age and sex-eligible patients. Analysis used generalized estimating equations Poisson modeling. Qualitative analysts developed case summaries and created a cross-case data display for comparison. RESULTS The results showed a reduction of 75% for colonoscopy [rate ratio (RR) = 0.250, 95% CI: 0.224-0.279], 78% for FIT/FOBT (RR = 0.218, 95% CI: 0.208-0.230), and 87% for Papanicolaou (RR = 0.130, 95% CI: 0.125-0.136) rates after the start of the pandemic. During this early pandemic period, CRC screening was impacted by hospitals halting services. Clinic staff moved toward FIT/FOBT screenings. CVC screening was impacted by guidelines encouraging pausing CVC screening, patient reluctance, and concerns about exposure. During the recovery period, leadership-driven preventive care prioritization and quality improvement capacity influenced CRC and CVC screening maintenance and recovery. CONCLUSIONS Efforts supporting quality improvement capacity could be key actionable elements for these health centers to endure major disruptions to their care delivery system and to drive rapid recovery.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Maria Danna
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Andrea Baron
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jennifer Hall
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Tahlia Hodes
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | | | - Heather Holderness
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Deborah J. Cohen
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
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Blavin FE, Smith LB, Dubay L, Basurto L. Assessing patterns in cancer screening use by race and ethnicity during the coronavirus pandemic using electronic health record data. Cancer Med 2023; 12:16548-16557. [PMID: 37347148 PMCID: PMC10469733 DOI: 10.1002/cam4.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Efforts to prevent the spread of the coronavirus led to dramatic reductions in nonemergency medical care services during the first several months of the COVID-19 pandemic. Delayed or missed screenings can lead to more advanced stage cancer diagnoses with potentially worse health outcomes and exacerbate preexisting racial and ethnic disparities. The objective of this analysis was to examine how the pandemic affected rates of breast and colorectal cancer screenings by race and ethnicity. METHODS We analyzed panels of providers that placed orders in 2019-2020 for mammogram and colonoscopy cancer screenings using electronic health record (EHR) data. We used a difference-in-differences design to examine the extent to which changes in provider-level mammogram and colonoscopy orders declined over the first year of the pandemic and whether these changes differed across race and ethnicity groups. RESULTS We found considerable declines in both types of screenings from March through May 2020, relative to the same months in 2019, for all racial and ethnic groups. Some rebound in screenings occurred in June through December 2020, particularly among White and Black patients; however, use among other groups was still lower than expected. CONCLUSIONS This research suggests that many patients experienced missed or delayed screenings during the first few months of the pandemic, which could lead to detrimental health outcomes. Our findings also underscore the importance of having high-quality data on race and ethnicity to document and understand racial and ethnic disparities in access to care.
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Affiliation(s)
- Fredric E. Blavin
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Lisa Dubay
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | - Luis Basurto
- Duke University, Sanford School of Public PolicyDurhamNorth CarolinaUSA
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Adams MA, Kerr EA, Gao Y, Saini SD. Impacts of COVID-19 on Appropriate Use of Screening Colonoscopy in a Large Integrated Healthcare Delivery System. J Gen Intern Med 2023; 38:2577-2583. [PMID: 37231209 PMCID: PMC10212219 DOI: 10.1007/s11606-023-08233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Decreasing low-value colonoscopy is critical to optimizing access for high-need patients, particularly in resource-constrained environments such as those created by the COVID-19 pandemic. We hypothesized that rates of screening colonoscopy overuse would decline during COVID compared to pre-COVID due to enhanced procedural scrutiny and prioritization in the setting of constrained access. OBJECTIVE To characterize impacts of COVID-19 on screening colonoscopy overuse DESIGN: Retrospective national cohort study using Veterans Health Administration administrative data PARTICIPANTS: Veterans undergoing screening colonoscopy in Q4 2019 (pre-COVID) and Q4 2020 (COVID) at 109 endoscopy facilities MAIN MEASURES: Rates of screening colonoscopy overuse KEY RESULTS: 18,376 screening colonoscopies were performed pre-COVID, 19% (3,641) of which met overuse criteria. While only 9,360 screening colonoscopies were performed in Q4 2020, 25% met overuse criteria. Overall change in median facility-level overuse during COVID compared to pre-COVID was 6% (95%CI 5%-7%), with significant variability across facilities (IQR: 2%-11%). Of colonoscopies meeting overuse criteria, the top reason for overuse in both periods was screening colonoscopy performed <9 years after previous screening procedure (55% pre-COVID, 49% during COVID). The largest shifts in overuse category were in screening procedures performed <9 years after prior screening colonoscopy (-6% decline COVID vs. pre-COVID) and screening procedures performed in patients below average-risk screening age (i.e., age <40 (5% increase COVID compared to pre-COVID), age 40-44 (4% increase COVID vs. pre-COVID)). Within facility performance was stable over time; 83/109 facilities changed their performance by <=1 quartile during COVID compared to pre-COVID. CONCLUSIONS Despite pandemic-related resource constraints and enhanced procedural scrutiny and prioritization in the setting of COVID-related backlogs, screening colonoscopy overuse rates remained roughly stable during COVID compared to pre-COVID, with continued variability across facilities. These data highlight the need for systematic and concerted efforts to address overuse, even in the face of strong external motivating factors.
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Affiliation(s)
- Megan A Adams
- Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
| | - Eve A Kerr
- Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yuqing Gao
- Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Sameer D Saini
- Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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Townsend JS. 2020 cancer incidence data in the USA reveal effects of the COVID-19 pandemic. Lancet Oncol 2023; 24:825-826. [PMID: 37541267 PMCID: PMC10513299 DOI: 10.1016/s1470-2045(23)00337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Julie S Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Han X, Yang NN, Nogueira L, Jiang C, Wagle NS, Zhao J, Shi KS, Fan Q, Schafer E, Yabroff KR, Jemal A. Changes in cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic in the USA: a cross-sectional nationwide assessment. Lancet Oncol 2023; 24:855-867. [PMID: 37541271 DOI: 10.1016/s1470-2045(23)00293-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The emergence of COVID-19 disrupted health care, with consequences for cancer diagnoses and outcomes, especially for early stage diagnoses, which generally have favourable prognoses. We aimed to examine nationwide changes in adult cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic by cancer type and key sociodemographic factors in the USA. METHODS In this cross-sectional study, adults (aged ≥18 years) newly diagnosed with a first primary malignant cancer between Jan 1, 2018, and Dec 31, 2020, were identified from the US National Cancer Database. We included individuals across 50 US states and the District of Columbia who were treated in hospitals that were Commission on Cancer-accredited during the study period. Individuals whose cancer stage was 0 (except for bladder cancer), occult, or without an applicable American Joint Committee on Cancer staging scheme were excluded. Our primary outcomes were the change in the number and the change in the stage distribution of new cancer diagnoses between 2019 (Jan 1 to Dec 31) and 2020 (Jan 1 to Dec 31). Monthly counts and stage distributions were calculated for all cancers combined and for major cancer types. We also calculated annual change in stage distribution from 2019 to 2020 and adjusted odds ratios (aORs) using multivariable logistic regression, adjusted for age group, sex, race and ethnicity, health insurance status, comorbidity score, US state, zip code-level social deprivation index, and county-level age-adjusted COVID-19 mortality in 2020. Separate models were stratified by sociodemographic and clinical factors. FINDINGS We identified 2 404 050 adults who were newly diagnosed with cancer during the study period (830 528 in 2018, 849 290 in 2019, and 724 232 in 2020). Mean age was 63·5 years (SD 13·5) and 1 287 049 (53·5%) individuals were women, 1 117 001 (46·5%) were men, and 1 814 082 (75·5%) were non-Hispanic White. The monthly number of new cancer diagnoses (all stages) decreased substantially after the start of the COVID-19 pandemic in March, 2020, although monthly counts returned to near pre-pandemic levels by the end of 2020. The decrease in diagnoses was largest for stage I disease, leading to lower odds of being diagnosed with stage I disease in 2020 than in 2019 (aOR 0·946 [95% CI 0·939-0·952] for stage I vs stage II-IV); whereas, the odds of being diagnosed with stage IV disease were higher in 2020 than in 2019 (1·074 [1·066-1·083] for stage IV vs stage I-III). This pattern was observed in most cancer types and sociodemographic groups, although was most prominent among Hispanic individuals (0·922 [0·899-0·946] for stage I; 1·110 [1·077-1·144] for stage IV), Asian American and Pacific Islander individuals (0·924 [0·892-0·956] for stage I; 1·096 [1·052-1·142] for stage IV), uninsured individuals (0·917 [0·875-0·961] for stage I; 1·102 [1·055-1·152] for stage IV), Medicare-insured adults younger than 65 years (0·909 [0·882-0·937] for stage I; 1·105 [1·068-1·144] for stage IV), and individuals living in the most socioeconomically deprived areas (0·931 [0·917-0·946] for stage I; 1·106 [1·087-1·125] for stage IV). INTERPRETATION Substantial cancer underdiagnosis and decreases in the proportion of early stage diagnoses occurred during 2020 in the USA, particularly among medically underserved individuals. Monitoring the long-term effects of the pandemic on morbidity, survival, and mortality is warranted. FUNDING None.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA.
| | - Nuo Nova Yang
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Changchuan Jiang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Elizabeth Schafer
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
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Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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Schiaffino S, Pinker K, Cozzi A, Magni V, Athanasiou A, Baltzer PAT, Camps Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Gilbert FJ, Helbich T, Kilburn-Toppin F, Kuhl CK, Lesaru M, Mann RM, Panizza P, Pediconi F, Sardanelli F, Sella T, Thomassin-Naggara I, Zackrisson S, Pijnappel RM. European Society of Breast Imaging (EUSOBI) guidelines on the management of axillary lymphadenopathy after COVID-19 vaccination: 2023 revision. Insights Imaging 2023; 14:126. [PMID: 37466753 DOI: 10.1186/s13244-023-01453-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/14/2023] [Indexed: 07/20/2023] Open
Abstract
Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach. As of 2023, according to newly acquired evidence, EUSOBI proposes the following updates, in order to reduce unnecessary examinations and avoid delaying necessary examinations. First, recommendation n. 3 has been revised to state that breast examinations should not be delayed or rescheduled because of COVID-19 vaccination, as evidence from the first pandemic waves highlights how delayed or missed screening tests have a negative effect on breast cancer morbidity and mortality, and that there is a near-zero risk of subsequent malignant findings in asymptomatic patients who have unilateral lymphadenopathy and no suspicious breast findings. Second, recommendation n. 7 has been revised to simplify follow-up strategies: in patients without breast cancer history and no imaging findings suspicious for cancer, symptomatic and asymptomatic imaging-detected unilateral lymphadenopathy on the same side of recent COVID-19 vaccination (within 12 weeks) should be classified as a benign finding (BI-RADS 2) and no further work-up should be pursued. All other recommendations issued by EUSOBI in 2021 remain valid.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Pascal A T Baltzer
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Thomas Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Yamaguchi S, Atarashi T, Okada A, Nasu S, Yamauchi T, Arase Y, Aizawa T, Nangaku M, Kadowaki T. Impact of the COVID-19 Pandemic on Health Check-ups: A Nationwide Questionnaire Survey in 639 Healthcare Facilities in Japan Society of Ningen Dock. JMA J 2023; 6:321-331. [PMID: 37560372 PMCID: PMC10407420 DOI: 10.31662/jmaj.2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Health check-ups have been disrupted worldwide by the COVID-19 pandemic, especially at its beginning. In Japan, undergoing annual check-ups is mandatory for full-time employees of all ages, while those other than full-time employees are entitled to undergo nonmandatory cancer screenings and specific health check-ups. To evaluate the impact of the COVID-19 pandemic on health check-ups, we conducted a nationwide questionnaire survey targeting healthcare facilities. METHODS A questionnaire survey was conducted between December 10, 2021, and January 28, 2022. Healthcare facilities were eligible if they were members of Japan Society of Ningen Dock and could respond via email. The monthly and yearly numbers of examinees undergoing mandatory or nonmandatory check-ups in 2020 and 2021 were compared with those in 2019. The proportions of examinees requiring follow-up visits and adhering to follow-up visits were compared between 2020 and 2019. Precautions taken against COVID-19 were also investigated. RESULTS Of the 1,299 eligible facilities, 639 participated (response rate, 49.2%). Health check-up services were suspended in 484 (75.7%) facilities for a median duration of 5 (interquartile range [IQR]: 4-8) weeks. A total of 19,861,230 and 21,748,125 examinees underwent health check-ups in 591 facilities in 2020 and 2021, respectively, 10.0% and 1.4% less than the numbers in 2019. The number of examinees undergoing health check-ups decreased by a median of 8.3% (IQR: -14.6 to -3.1) in 2020 compared to that in 2019, with the largest decrease of 70.3% (IQR -87.9 to -48.5) in May. Although the number of examinees undergoing mandatory check-ups increased in 2021 compared with that in 2019, the number of those undergoing nonmandatory check-ups remained low. CONCLUSIONS While people eligible for mandatory check-ups were adherent to check-ups in 2021, those ineligible for mandatory check-ups seemed less adherent. Public health efforts to encourage these people to adhere to check-ups during the pandemic are required.
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Affiliation(s)
- Satoko Yamaguchi
- Department of Prevention of Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Atarashi
- Japan Society of Ningen Dock, Tokyo, Japan
- Medical Check-up Center, JA Hokkaido P.W.F.A.C. Obihiro-Kosei General Hospital, Hokkaido, Japan
| | - Akira Okada
- Department of Prevention of Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeru Nasu
- Japan Society of Ningen Dock, Tokyo, Japan
- Hakuaikai Hospital, Fukuoka, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuji Arase
- Japan Society of Ningen Dock, Tokyo, Japan
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Takao Aizawa
- Japan Society of Ningen Dock, Tokyo, Japan
- Aizawa Hospital, Nagano, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Toranomon Hospital, Tokyo, Japan
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Mani SS, Schut RA. The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health. Soc Sci Med 2023; 328:116003. [PMID: 37301108 PMCID: PMC10238126 DOI: 10.1016/j.socscimed.2023.116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.
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Affiliation(s)
- Sneha Sarah Mani
- Graduate Group in Demography, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
| | - Rebecca Anna Schut
- Center for Health and the Social Sciences, The University of Chicago, Chicago, IL, USA.
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Gopalani SV, Soman A, Shapiro JA, Miller JW, Ortiz-Ortiz KJ, Castañeda-Avila MA, Buenconsejo-Lum LE, Fredericks LE, Tortolero-Luna G, Saraiya M. Breast, cervical, and colorectal cancer screening test use in the US territories of Guam, Puerto Rico, and the US Virgin Islands. Cancer Epidemiol 2023; 84:102371. [PMID: 37105018 PMCID: PMC10594602 DOI: 10.1016/j.canep.2023.102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The United States Preventive Services Task Force (USPSTF) recommends breast, cervical, and colorectal cancer screening among eligible adults, but information on screening use in the US territories is limited. METHODS To estimate the proportion of adults up-to-date with breast, cervical, and colorectal cancer screening based on USPSTF recommendations, we analyzed Behavioral Risk Factor Surveillance System data from 2016, 2018, and 2020 for the 50 US states and DC (US) and US territories of Guam and Puerto Rico and from 2016 for the US Virgin Islands. Age-standardized weighted proportions for up-to-date cancer screening were examined overall and by select characteristics for each jurisdiction. RESULTS Overall, 67.2% (95% CI: 60.6-73.3) of women aged 50-74 years in the US Virgin Islands, 74.8% (70.9-78.3) in Guam, 83.4% (81.7-84.9) in Puerto Rico, and 78.3% (77.9-78.6) in the US were up-to-date with breast cancer screening. For cervical cancer screening, 71.1% (67.6-74.3) of women aged 21-65 years in Guam, 81.3% (74.6-86.5) in the US Virgin Islands, 83.0% (81.7-84.3) in Puerto Rico, and 84.5% (84.3-84.8) in the US were up-to-date. For colorectal cancer screening, 45.2% (40.0-50.5) of adults aged 50-75 years in the US Virgin Islands, 47.3% (43.6-51.0) in Guam, 61.2% (59.5-62.8) in Puerto Rico, and 69.0% (68.7-69.3) in the US were up-to-date. Adults without health care coverage reported low test use for all three cancers in all jurisdictions. In most jurisdictions, test use was lower among adults with less than a high school degree and an annual household income of < $25,000. CONCLUSION Cancer screening test use varied between the US territories, highlighting the importance of understanding and addressing territory-specific barriers. Test use was lower among groups without health care coverage and with lower income and education levels, suggesting the need for targeted evidence-based interventions.
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Affiliation(s)
- Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Jean A Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline W Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen J Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Maira A Castañeda-Avila
- Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Lyña E Fredericks
- Division of Chronic Disease and Prevention, US Virgin Islands Department of Health, St. Thomas, USVI, USA
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Barger MK, Howe-Heyman A, Harris NR. Systematic Reviews to Inform Practice, May/June 2023. J Midwifery Womens Health 2023; 68:395-403. [PMID: 37212532 DOI: 10.1111/jmwh.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Mary K Barger
- Midwifery researcher and consultant, San Diego, California
| | | | - Nena R Harris
- Family Nursing, Frontier Nursing University, Fort Mill, South Carolina
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Lomahan S, Rauscher GH, Murphy AM. The role of facility and patient mix factors on recovery of screening and diagnostic mammography volumes following the initial COVID-19 pandemic wave. Cancer Med 2023; 12:10877-10888. [PMID: 36924321 PMCID: PMC10225188 DOI: 10.1002/cam4.5793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The goal of this study was to understand the extent to which mammography facilities were able to recover monthly screening and diagnostic mammography volumes to their prepandemic levels and to determine what facility and patient mix factors were associated with recovery. METHOD Facilities, located in and adjacent to Cook County, Illinois, were eligible. In all, 58 screening and 30 diagnostic mammogram facilities submitted mammogram volumes by month with a cross-listing of patient ZIP codes by screening volumes. Monthly screening and diagnostic volumes for the 6-month immediate postpandemic period (July-December 2020) and for the subsequent postpandemic period (January-June 2021) were compared with the same months in 2019. ZIP code distributions were used to define patient mix characteristics related to disadvantage. RESULTS Compared with the prepandemic period, Breast Imaging Centers of Excellence conducted roughly 50 fewer monthly screening mammograms (95% CI: -91, -9) but 50 more diagnostic mammograms (95% CI: 24, 82) on average in the immediate postpandemic period. Facilities serving a predominantly Black population conducted roughly 50 fewer monthly screens (95% CI: -93, -13) without any increase in monthly diagnostics. CONCLUSION Highly accredited (and typically higher volume) facilities appeared to actively triage diagnostics, whereas lower resource facilities appeared to struggle to recover to prepandemic volumes without triage to diagnostics. The pandemic disproportionally impacted minority populations already affected by differential access to and utilization of high-quality mammography. Potential explanations are discussed. Policies should be strengthened to facilitate triaging of services during times of stress to the healthcare system.
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Affiliation(s)
| | - Garth H. Rauscher
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
- University of Illinois Cancer CenterChicagoIllinoisUSA
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Garrido-cantero G, Longo F, Hernández-gonzález J, Pueyo Á, Fernández-aparicio T, Dorado JF, Angulo JC, on behalf of the Madrid Cancer Registry (RTMAD) Investigators. Impact of the COVID-19 Pandemic on Cancer Diagnosis in Madrid (Spain) Based on the RTMAD Tumor Registry (2019–2021). Cancers (Basel) 2023; 15:1753. [PMID: 36980640 PMCID: PMC10046347 DOI: 10.3390/cancers15061753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a significant disruption to cancer diagnosis, treatment and prevention worldwide that could have serious consequences in the near future. We intend to evaluate the weight of this backlog on a community-wide scale in Madrid during the period 2020–2021, and whether a stage shift towards the advanced stage has occurred. Cancer diagnoses in the Madrid tumor registry (RTMAD) from 2019–2021 were evaluated. Absolute and percentage differences in annual volume and observed-to-expected (O/E) volume ratios were calculated. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated using the O/E ratio. The SIR for 2020–2021 compared to 2019 was 94.5% (95% CI 93.8–95.3), with unequal gender-specific cancer diagnosis recovery (88.5% for males and 102.1% for females). Most cancer types were underdiagnosed in 2020. The tendency worsened in 2021 for colorectal and prostate cancers (87.8%), but lung cancer recovered (102.1%) and breast cancer was over-diagnosed (114.4%) compared with reference pre-COVID-19 data. These changes have modified the ranking of the most frequent malignancies diagnosed in Madrid. Breast cancer has overtaken colorectal and prostate cancers, displaced to second and third position, respectively. Not only was colorectal cancer diagnosis affected more as a consequence of the COVID-19 pandemic but diagnosis of this malignancy at the advance stage also increased by 3.6% in 2020 and 4.2% in 2021 compared to the reference period of 2019. In summary, there is a large volume of undetected cancer in Madrid caused by the reduced access to care secondary to the COVID-19 pandemic, especially regarding colorectal and prostate cancer. Strategies are needed to recover the backlog of diagnoses and effectively treat these cases in the future and solve the negative impact that will be caused by the diagnostic delay. Analyzing the impact of new diagnoses suffered by each different malignancy and their recovery will help to understand how the future allocation of resources should look.
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Wiese D, Islami F, Henry KA. Changes in geographic accessibility to mammography by state and rural-urban status, United States, 2006-2022. J Natl Cancer Inst 2023; 115:337-340. [PMID: 36515214 PMCID: PMC9996203 DOI: 10.1093/jnci/djac217] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Although mammography is widely available in the United States, differences in accessibility in rural and urban areas and changes over time are not well described. In this study, we estimated the number and proportion of women aged 45-84 years who had limited travel time-based geographic accessibility to mammography by urban-rural status and state in the contiguous United States in 2006 and 2022. The proportion of women aged 45-84 years with limited accessibility to mammography did not substantially change from 2006 (12.7%; representing 7.5 million women) to 2022 (12.2%; 8.2 million women). Accessibility to mammography varied by state, but in 10 states, more than 26% of the statewide female population aged 45-84 years had limited accessibility in 2022. This proportion was substantially higher in rural areas (50.6% overall; ≥50% in 28 states in 2022) than in urban areas (3.0% overall). Increasing accessibility to mammography could increase utilization of breast cancer screening and, potentially, improve breast cancer survival.
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Affiliation(s)
- Daniel Wiese
- Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA.,Department of Geography and Urban Studies, Temple University, Philadelphia, PA, USA
| | - Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Kevin A Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, USA.,Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, PA, USA
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Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC statistics based on incidence from population-based cancer registries and mortality from the National Center for Health Statistics. In 2023, approximately 153,020 individuals will be diagnosed with CRC and 52,550 will die from the disease, including 19,550 cases and 3750 deaths in individuals younger than 50 years. The decline in CRC incidence slowed from 3%-4% annually during the 2000s to 1% annually during 2011-2019, driven partly by an increase in individuals younger than 55 years of 1%-2% annually since the mid-1990s. Consequently, the proportion of cases among those younger than 55 years increased from 11% in 1995 to 20% in 2019. Incidence since circa 2010 increased in those younger than 65 years for regional-stage disease by about 2%-3% annually and for distant-stage disease by 0.5%-3% annually, reversing the overall shift to earlier stage diagnosis that occurred during 1995 through 2005. For example, 60% of all new cases were advanced in 2019 versus 52% in the mid-2000s and 57% in 1995, before widespread screening. There is also a shift to left-sided tumors, with the proportion of rectal cancer increasing from 27% in 1995 to 31% in 2019. CRC mortality declined by 2% annually from 2011-2020 overall but increased by 0.5%-3% annually in individuals younger than 50 years and in Native Americans younger than 65 years. In summary, despite continued overall declines, CRC is rapidly shifting to diagnosis at a younger age, at a more advanced stage, and in the left colon/rectum. Progress against CRC could be accelerated by uncovering the etiology of rising incidence in generations born since 1950 and increasing access to high-quality screening and treatment among all populations, especially Native Americans.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Abstract
Colorectal cancer (CRC) is among the most common cancers globally and a major cause of cancer-related deaths. The American Cancer Society estimates that CRC will kill 1 in 60 Americans, and CRC screening is recommended for all Americans ≥45 years of age. Current CRC screening methods are effective for preventing CRC and have been shown to reduce CRC-related mortality. However, none of the currently available tests is ideal, and many people are not compliant with screening recommendations. Novel screening tests based on advances in CRC molecular biology, genetics, and epigenetics, combined with developments in sequencing technologies and computational analytic methods, have been developed to address the shortcomings of current CRC screening tests. These emerging tests include blood-based assays that use plasma-derived circulating tumor DNA and serum proteins to detect early CRC and advanced adenomas, assays that use stool DNA or mRNA, and methods for profiling the gut microbiome. Here we review current screening modalities, and we discuss the principles behind the most promising emerging CRC screening tests and the data supporting their potential to be used in clinical practice.
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Affiliation(s)
- Marina Hanna
- Department of Medicine, University of Washington, Seattle, Washington
| | - Neelendu Dey
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Microbiome Research Initiative, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - William M Grady
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
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