Cancer Diagnoses Plunge as Americans Avoid Screening During Pandemic
As COVID-19 continues to impact nearly all aspects of American health care, researchers warn that the United States has seen a troubling drop in cancer diagnoses since the pandemic began.
The drop is not being attributed to a downturn in cancer incidence, but rather a COVID-driven reluctance to get screened.
"Our research found that during the COVID-19 pandemic, between March 1 and April 18, there was a 46% decrease in diagnoses of the six common cancer types we looked at, which included breast, colorectal, lung, pancreatic, gastric and esophageal cancers," said study author Dr. Harvey Kaufman.
But, "this decrease in diagnoses was unfortunately not the result of a drop in cancer rates," stressed Kaufman, who is senior medical director of medical informatics at Quest Diagnostics in Secaucus, N.J. Instead, it appears to be the direct consequence of public health guidance that was promoted during the early days of the pandemic.
"During the pandemic, the U.S. Centers for Disease Control and Prevention and many medical professional organizations recommended that cancer screening -- and other health prevention services -- should be postponed unless the risks outweighed the benefits," Kaufman noted. "This guidance resulted in patients avoiding the doctor's office and fewer cancer screenings, which affected the diagnosis and treatment rates of cancers and other life-threatening conditions."
To track cancer diagnosis rates, the team reviewed cancer screening medical codes for almost 279,000 patients who underwent testing for six cancers between January 2018 and April 18, 2020.
The vast majority (75%) were women, at an average age of 66.
The investigators broke up the study period into two phases: pre-COVID-19 (Jan. 6, 2019 through Feb. 29, 2020) and COVID-19 (March 1 through April 18, 2020).
Once stacked up against each other, the two periods revealed a 46% drop in weekly diagnoses among all six cancers combined.
Some cancer screenings saw a more precipitous drop than others, with breast cancer diagnoses experiencing the biggest plunge (52%). But even the smallest dip was significant, as pancreatic cancer diagnoses fell off by almost 25%, the findings showed.
But the United States is not alone in this trend. In fact, the study team pointed out that The Netherlands Cancer Registry is reporting a 40% decline in weekly cancer diagnoses since the pandemic began, while British cancer referral rates have dropped 75%.
The problem? While cancer diagnoses may be happening less often, cancer itself is not taking a break.
"When cancer screenings and resulting cancer diagnoses are postponed, some of these cancers are likely to later be identified at more advanced stages, which will result in poorer outcomes and even increased death rates," Kaufman said. "Whereas postponing dental cleanings may lead to more plaque build-up and gum disease, delay in cancer diagnosis and treatment will have more severe consequences for some patients."
The Dana-Farber Cancer Institute, in Boston, echoed the point in a statement.
"The true incidence of these cancers did not drop," said Dr. Craig Bunnell, Dana-Farber's chief medical officer. "The decline clearly represents a delay in making the diagnoses, and delays matter with cancer. It means we need to safely perform these diagnostic tests and the public needs to not think of them as optional. Their lives could depend on them."
Laura Makaroff, senior vice president of prevention and early detection with the American Cancer Society, agreed, warning that "cancer certainly isn't stopping due to the pandemic."
But screening patterns seen early on in the pandemic may shift over time, she added. "More recently, we are seeing some signs that screening rates are recovering some," Makaroff said.
"There are still gaps and we are not back to where screening rates were pre-pandemic," she stressed. "But health care providers across the country are working hard to implement processes to keep patients safe and get people back in for screening when they are due."
Kaufman said doing so is critical.
"Urgent action needs to be taken to avoid a potential increase in cancer deaths in the U.S. due to delayed diagnoses and treatment," he said. "Patients and their health care providers should resume routine preventative care, including cancer screenings in safe health care environments."
The report was published online Aug. 4 in JAMA Network Open.
There's more on cancer screening advice during the pandemic at the American Cancer Society.
SOURCES: Harvey Kaufman, MD, senior medical director, medical informatics, Quest Diagnostics, Secaucus, N.J.; Laura Makaroff, DO, senior vice president, prevention and early detection, American Cancer Society; Craig Bunnell, MD, chief medical officer, Dana-Farber Cancer Institute, Boston; JAMA Network Open, Aug. 4, 2020, online