medwireNews: A systematic review and meta-analysis has identified global decreases in breast, cervical, and colorectal cancer screening during the early phase of the COVID-19 pandemic.
“The interruption of cancer screening could delay diagnosis of tumors, causing a shift to more advanced stages at diagnosis,” write Paolo Boffetta and colleagues from the University of Bologna in Italy in JAMA Oncology.
“Furthermore, this could be associated with increased avoidable cancer deaths, aggravate the patients’ discomfort and disease burden, and be associated with increased workload for medical personnel and increased costs for the health care system.”
The team therefore says: “Effective interventions are required to restore the capacity of screening services to the prepandemic level.”
The meta-analysis included 39 cancer registry-based studies that compared the number of screening tests for breast, cervical, and colorectal cancer during the pandemic period (January–October 2020) with a specified pre-COVID-19 period.
Boffetta et al explain that they focused on “the types of cancer screening recommended for the general population by the US Preventive Services Task Force,” and “excluded screening types performed for high-risk individuals (eg, lung cancer screening) and those with lower-grade recommendation (eg, prostate cancer screening).”
They found that breast cancer screening decreased by an average of 46.7% during versus before the pandemic, while cervical cancer screening declined by 51.8% and colorectal cancer screening by 44.9%.
“Beyond the decision to interrupt all cancer screening programs, the main factors that may have caused this reduction were stay-at-home orders, people’s fear of the infection, avoidance of non-urgent medical treatment and care, limited access to in-person medical examinations, and the reorganization of hospital departments,” writes the team.
For both breast and colorectal cancer screening, the greatest reduction was observed in April 2020, at 74.3% and 69.3%, respectively. But whereas there was no significant decline in breast cancer screening from June 2020 onwards, colorectal cancer screening only recovered partially, with a significant reduction of 23.4% in June–October 2020, report the researchers.
The greatest decrease for cervical cancer was during March 2020, at 78.8%.
“Differences by geographic area and screening setting were also identified,” say Boffetta and colleagues. For instance, the largest reduction in breast cancer screening was observed in Europe, at an average of 67.7% versus 44.6% for North America and 51.1% for South America.
They speculate that this difference could be due to “the fact that in the United States, [mammograms] are mostly performed through private health insurance, whereas in Europe, they are usually provided as part of the public health care system.”
Discussing the limitations of the study, the investigators note that “considerable heterogeneity between countries was present in terms of screening protocols, services’ accessibility and participation of the target population, lockdown measures, and incidence of COVID-19 and its temporal trend; all of these factors could not be considered in our statistical analysis.”
And they conclude: “Future studies on variations in screening numbers will need to be performed to clarify long-term implications and adopt adequate public health strategies.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
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