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After cancer screenings fell during COVID-19, an effort to reverse the trend

Cancer screening rates have largely remained below pre-pandemic levels at least through early 2021, but health providers are taking aim at reducing the deficit.

Given the worrisome drop in cancer screenings seen since the onset of the COVID-19 pandemic, health care facilities across the United States have been mobilizing to make-up for lost time.

The overarching goal is to mitigate the considerably harmful impact delayed cancer detection can have.

A paper published on Monday in the journal Cancer offers good news and bad news on this front. The bad news, which comes as no surprise to researchers, is that cancer screening rates have largely remained below pre-pandemic levels at least through early 2021, especially for colorectal cancer. The good news is there has been considerable buy-in from health care providers to reverse these concerning deficits.

“The reason that screening is promoted in the first place is because it’s been shown to save lives,” Dr. Heidi Nelson, the medical director of the American College of Surgeons and a coauthor of the new paper told TODAY. “Screening allows us to find cancers early, when they’re more treatable. This reduces the risk of suffering from advanced cancer.”

A study published in JAMA Oncology in April 2021 estimated that through July 2020 alone, the disruptions stemming from the pandemic led Americans to miss more than 9 million screenings for breast, colorectal and prostate cancers. Such findings followed a June 2020 projection by National Cancer Institute (NCI) Director Dr. Norman E. Sharpless that pandemic-driven missed screenings would lead to an additional 10,000 deaths from breast and colorectal cancers alone.

“The reason that screening is promoted in the first place is because it’s been shown to save lives. Screening allows us to find cancers early, when they’re more treatable. This reduces the risk of suffering from advanced cancer.”

Dr. Heidi Nelson, medical director of the American College of Surgeons

The most commonly diagnosed cancers in the United states include breast, prostate, lung, skin (melanoma) and bladder cancer, according the NCI. Those that cause the greatest deaths include lung, pancreatic, colorectal, breast and prostate cancer.

Dr. Jennifer Croswell, a medical officer in the NCI Division of Cancer Control & Population Sciences, told TODAY that COVID-19 has “impacted cancer care along its whole continuum. That includes screening, but also diagnostic follow-up and treatment.”

During the spring of 2021, Nelson and her coauthors enrolled nearly 750 U.S. cancer programs into a massive initiative to drive up cancer screening rates. Groups such as the American College of Surgeons Cancer Programs and the American Cancer Society are collaborating in this effort and are working on three major fronts:

  • Community. This includes social media and local news campaigns to alert the public to the importance of cancer screening.
  • Health care settings. Health care providers have been urged to get patients back into receiving cancer screenings and to reassure them about COVID-related safety precautions in health care settings.
  • Individual patients. Urgent reminders and alerts are being sent to patients to get them to come in for cancer screenings.  

Nelson and her colleagues compared the monthly cancer screening rates the health care providers reported during the pre-pandemic months of September 2019 and January 2020 with the rates in the corresponding pair of months one year later.

The vast majority of programs saw declines in screening rates by September 2020 and January 2021.

The most concerning finding was the median 17.7% drop in the screening rate for colorectal cancer. There were smaller median declines in screening for cervical and breast cancer, of 6.8% and 1.6%, respectively. The median lung cancer screening rate, however, actually increased slightly, by 1.2%.

The drop in colorectal cancer screening was in line with the 2021 JAMA Oncology paper. This found that the colorectal screening rate was 13.1% lower in July 2020 compared with 2019, while screening for breast and prostate cancers had almost entirely rebounded from their springtime plunge by that first mid-summer of the pandemic.

Nelson suggested that the colorectal cancer tests likely dropped substantially because a colonoscopy, which is recommended to detect such cancer starting once most people turn 45, is an invasive procedure. People concerned about coronavirus transmission may have shied away.

On the bright side, Nelson said it was “really gratifying” that so many cancer facilities have engaged with the initiative to increase screenings. She and her colleagues are currently busy collecting data to assess the impacts of this effort.

“Even though there were real gaps in screening rates,” Nelson said, “I’m optimistic that we will see that we’ve reversed the trends and hopefully put some of this is behind us.”

“Cancer care continues despite the pandemic, and we need to make extra efforts to make sure that everyone gets the care that they deserve,” added Dr. Quoc-Dien Trinh, co-director of the Dana-Farber/Brigham and Women’s Prostate Cancer Program in Boston.

Related: Why you should get cancer screenings and when