Millions of screenings for breast and cervical cancer were missed during the first year of the Covid-19 pandemic, according to a new study published in JAMA Network Open.

Case study: 9 innovative strategies to improve cancer screening

Study details and key findings

For the study, researchers from the American Cancer Society (ACS) and Emory University analyzed responses to Behavioral Risk Factor Surveillance System survey for 2014, 2016, 2018, and 2020 from women eligible for breast cancer (ages 50 to 74) and cervical cancer (ages 25 to 64) screenings and men and women eligible for colorectal cancer (ages 50 to 75) screenings.

3 steps to take in advance of a wave of 'missed' cancers

In total, 479,248 women were included for the breast cancer screening evaluations, 301,453 women were included for cervical cancer screenings, and 854,210 men and women were included for colorectal cancer screenings. All data was analyzed between September 2021 and February 2022.

Overall, the researchers found that breast cancer screenings dropped 6% and cervical cancer screenings dropped 11% from 2018 and 2020. This equates to 2.3 million missed breast cancer screenings and 4.47 million missed cervical cancer screening.

The group that saw the largest decline in breast cancer screenings was Asian and Pacific Islander women (27%), while the group that saw the largest decline in cervical cancer screenings was Hispanic women (17%). In addition, individuals without high school diplomas saw higher declines for breast cancer and cervical cancer screenings (11% and 17.7%, respectively) than those who were college graduates (6.1% and 9.5%, respectively).

In comparison, colorectal cancer screenings remained fairly stable across all the years included in the study period. Although colonoscopies declined by 16% between 2018 and 2020, stool testing increased by 7% during the same period, partially offsetting the decrease. According to the authors, this finding suggests that at-home cancer testing may help maintain population-wide screenings during major health care disruptions, including pandemics.

Breast, cervical, and colorectal cancer screening rates

Commentary

According to Ahmedin Jemal, SVP of surveillance and health equity at ACS and the study's senior author, cancer screenings fell almost 80% during the early days of the pandemic after elective procedures were delayed or canceled and patients began to avoid health care settings over coronavirus concerns.

Resource library: Cancer screening programs

"Many people caught up on screenings later in 2020, but overall, the COVID-19 pandemic kept screenings down over the course of the entire year," Jemal said. "As we move forward, it's crucial to get people back into their doctor's offices to get screened."

Although the effects of delayed or missed cancer screenings is still unknown, Jemal noted that they should be closely monitored over time. "It is imperative that we understand the impact of lower screening rates on cancer outcomes among people of color and people of lower socioeconomic standing and also work to improve access to health care and cancer screenings for everyone," he said.

In addition, William Dahut, ACS's chief scientific officer, encouraged people to regularly get cancer screenings, saying that they are both safe and effective. "Facilities that offer screening services have COVID-19 safety precautions in place," he said. "Many states have low or reduced-cost screening programs to help ensure that everyone has access, even people who don’t have insurance or a primary care doctor." (Van Beusekom, CIDRAP News, 6/3; Fedewa et al., JAMA Network Open, 6/3; Gleeson, Becker's Hospital Review, 6/6)