A new review of cancer screening data conducted by researchers at Stony Brook University’s Renaissance School of Medicine found that across the globe, fewer people received these vital and possibly lifesaving procedures during the first year of the COVID-19 pandemic.
The study, recently published in JAMA Oncology, showed that between January 2020 to October 2020, screening for breast cancer dropped 35.6%, for colorectal cancer by 41.8% and for cervical cancer by 54.1%.
During the early days of the pandemic, many medical facilities were closed or resources were redirected to assisting COVID-19 patients. But even after doctors started offering screenings again, many patients were wary of entering such facilities for fear of contracting COVID-19, scientists have said.
Experts have expressed concern that delayed screenings will lead to more incidences of cancer or a progression of some cancers. At one point, the National Cancer Institute had estimated these delays would result in 10,000 additional deaths due to breast and colon cancer in the coming years. But most researchers now agree it's too soon to know the actual impact of deferred screenings.
“Cancer screening remains an important tool to fight cancer incidence and morbidity and mortality caused by these diseases worldwide,” said Dr. Paolo Boffetta, lead author of the study and associate director for population sciences at the Stony Brook Cancer Center. “And the COVID-19 pandemic has clearly affected public health services, including cancer screening tests, during parts or throughout the entire pandemic.”
Boffetta said he believes delayed screenings will lead to a higher incidence of colorectal and cervical cancers because they detect preneoplastic lesions, cells that could grow into cancer unless they are addressed.
The lack of screening for some other cancers could mean catching the disease at a later stage, he said.
“In the case of cancers for which screening detects early-stage cancers, such as breast cancer, the decrease in screening will lead to a stage shift but not an increased incidence,” he said.
The drops in screenings were not uniform, the study showed. By June 2020, the decrease in breast and cervical cancer screenings had slowed.
“This was somewhat surprising, showing resilience of the health systems providing screening,” Boffetta said.
However, the delays persisted with colorectal cancer until the end of 2020, the study said.
Boffetta worked with colleagues at Stony Brook and the University of Bologna in Italy to compile data published in medical journals from 19 countries. They examined the number of screening tests done before and during the pandemic.
“This mirrors our experience,” said Dr. Bhoomi Mehrotra, chairman of Cancer Services at Catholic Health, including four institutions on Long Island that partner with the American Cancer Society. “At that time, the health systems were just trying to cope with COVID-19.”
He said toward the end of 2020 and beginning of 2021, people started going back to their primary care physicians. But problems with access to screening for all patients remain an issue.
Last month, the American Cancer Society released research that showed the number of women in the United States who reported having a recent (in the past year) breast cancer or cervical cancer screening dropped by 2.13 million (6%) and 4.47 million (11%) in 2020 when compared with 2018.
The drops were sharper for Hispanic women and people with lower incomes, the statistics showed.
“We are still grappling with diversity in our demographics and removing the barriers to care that impact Hispanic and African-American communities,” Mehrotra said.
And he emphasized the need to screen for all cancers including skin, colorectal, cervical and lung to find — when possible — cells in the precancerous phase.
“In this cycle with COVID-19, it’s imperative that we educate our communities,” he said. “Cancer is not going to wait for this pandemic to be over … we need to pick it up early if it is there.”