The potential impact of missed screenings during the Covid-19 pandemic continues to be a concern for health care leaders, particularly considering the National Cancer Institute's predictions that missed screenings will lead to 2,500 additional breast cancer deaths and 5,000 additional colorectal cancer deaths in the United States over the next decade.
Millions of people missed or delayed cancer screenings during the peak of the pandemic in 2020, which we know led to significantly fewer new cancer diagnoses than expected during this period.
However, we're less certain about how these delayed diagnoses will impact stage shift and mortality. We know that delayed diagnoses could lead to more late-stage cancer diagnoses which could in turn lead to more deaths, but we've only been able to make predictions about the extent to which either of these possibilities will happen, if at all. Until recently.
Late-stage cancer diagnoses may be increasing
Preliminary evidence has shown that more patients have been diagnosed with advanced cancers following the peak pandemic period, indicating these concerns about the impact of missed screenings on stage shift and mortality are not unfounded.
However, we can't confidently say that missed screenings are causing an overall increase in advanced cancers, or deaths, yet based solely on this preliminary data. There are still so many unanswered questions that prevent us from confidently predicting the true downstream impact of missed screenings during the pandemic without more robust, nationally representative, and longer-term data.
Top 7 unanswered questions about the impact of missed screenings during the pandemic
Our biggest question is: How will the phenomenon of cancer overdiagnosis affect the number of additional advanced cancer diagnoses and deaths from missed screenings? Overdiagnosis refers to the finding of cancers that would never have progressed to the point where they would cause symptoms or premature death. If some of the patients who missed screenings during the peak pandemic period would have been "overdiagnosed", no amount of delay in their diagnosis would result in a late-stage cancer or an increased risk of death.
This could mean that there may be a smaller increase in advanced cancers and deaths than currently expected, as well as potentially an unexpected decrease in cancer costs and improvement of patient quality of life from reducing the amount of unnecessary treatment received by "overdiagnosed" patients (aka overtreatment).
Here are 6 other questions that are top of mind for us:
- How did the number of missed cancer screenings, and thus the downstream impact on advanced cancers and deaths, vary by patient population? For example, based on patient demographic characteristics, cancer type, or severity of the pandemic's impact on different communities.
- How long were cancer diagnoses delayed, and was it long enough for cancers to progress from early stage to late stage?
- How many patients who missed their cancer screening had an incidental cancer finding while receiving medical care (e.g., imaging tests) for Covid-19 that may have reduced the potential length of their delay in diagnosis and subsequent risk of being diagnosed at an advanced stage?
- How will the increasing number of treatment options for late-stage cancers affect how much of an impact more advanced cancer diagnoses could have on mortality?
- How will other consequences of the pandemic besides the potential increase in advanced cancers, such as the long-term health effects of having Covid-19, impact mortality?
- How will missed screenings, delayed diagnoses, and a potential increase in advanced cancer diagnoses impact other aspects of cancer care besides mortality, such as treatment patterns, costs, and patient quality of life?
Although it goes without saying that it's important to get patients (particularly those at highest risk for cancer) back in for screening, these questions—and others like them—will need to be answered before we are able to confidently predict the full impact of the missed screenings during the pandemic on cancer care and patient outcomes. Until then, it will be difficult for oncology stakeholders to effectively plan for the future.
To solve this common challenge, it will be critical for all oncology stakeholders to work together and do their part to collect and share the necessary data to answer these questions as quickly as possible. Oncology leaders should regularly iterate on their plans for the future as we learn new information about the impact of missed cancer screenings during the pandemic.
