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Robles C, Monfil L, Ibáñez R, Roura E, Font R, Peremiquel-Trillas P, Brotons M, Martínez-Bueno C, de Sanjosé S, Espinàs JA, Bruni L. Impact of the COVID-19 pandemic on cervical cancer screening participation, abnormal cytology prevalence and screening interval in Catalonia. Front Oncol 2024; 14:1338859. [PMID: 38873256 PMCID: PMC11171128 DOI: 10.3389/fonc.2024.1338859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Background The COVID-19 pandemic led to a national lockdown and the interruption of all cancer preventive services, including cervical cancer screening. We aimed to assess the COVID-19 pandemic impact on opportunistic screening participation, abnormal cytology (ASCUS+) prevalence and screening interval in 2020 and 2021 within the Public Health System of Catalonia, Spain. Methods Individual data on cytology and HPV testing of women aged 25-65 from 2014 to 2021 were retrieved from the Information System for Primary Care Services (SISAP). Time-series regression models were used to estimate expected screening participation and abnormal cytology prevalence in 2020 and 2021. The impact was determined by comparing observed and expected values (ratios). Additionally, changes in screening interval trends between 2014 and 2021 were assessed by fitting a Piecewise linear regression model. Results Cervical cancer screening participation decreased by 38.8% and 2.2% in 2020 and 2021, respectively, with the most significant impact on participation (-96.1%) occurring in April 2020. Among older women, participation was lower, and it took longer to recover. Abnormal cytology prevalence was 1.4 times higher than expected in 2020 and 2021, with variations by age (range=1.1-1.5). From June 2020 onwards, the screening interval trend significantly changed from an increase of 0.59 to 3.57 months per year, resulting in a median time of 48 months by December 2021. Conclusions During the pandemic, fewer women have participated in cervical cancer screening, abnormal cytology prevalence has increased, and the screening interval is more prolonged than before. The potential cervical cancer lifetime risk implications highlight the need for organized HPV-based screening.
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Affiliation(s)
- Claudia Robles
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Monfil
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Ibáñez
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Esther Roura
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Rebeca Font
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain
| | - Paula Peremiquel-Trillas
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Maria Brotons
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Cristina Martínez-Bueno
- University of Barcelona, Barcelona, Spain
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Catalunya, Institut Català de la Salut, Barcelona, Spain
- Grup de Recerca en Salut Sexual i Reproductiva (GRASSIR), Barcelona, Spain
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Institut de Salut Global (ISGlobal), Barcelona, Spain
| | | | - Laia Bruni
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
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Peacock HM, van Walle L, Silversmit G, Neven P, Han SN, Van Damme N. Breast cancer incidence, stage distribution, and treatment shifts during the 2020 COVID-19 pandemic: a nationwide population-level study. Arch Public Health 2024; 82:66. [PMID: 38715074 PMCID: PMC11075279 DOI: 10.1186/s13690-024-01296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The first COVID-19 wave in 2020 necessitated temporary suspension of non-essential medical services including organized cancer screening programs in Belgium. This study assessed the impact of the pandemic on breast cancer (BC) incidence, stage at diagnosis, and management in Belgium in 2020. METHODS All Belgian residents diagnosed with in situ or invasive BC in 2015-2020 in the nationwide, population-based cancer registry database were included. Incidence trends for 2015-2019 were extrapolated to predict incidence and stage distribution for 2020 and compared with the observed values. National healthcare reimbursement data were used to examine treatment strategies. Exact tumor diameter and nodal involvement, extracted from pathology reports, were analyzed for 2019 and 2020. RESULTS 74,975 tumors were selected for analysis of incidence and clinical stage. Invasive BC incidence declined by -5.0% in 2020, with a drop during the first COVID-19 wave (Mar-Jun; -23%) followed by a rebound (Jul-Dec; +7%). Predicted and observed incidence (in situ + invasive) was not different in patients < 50 years. In the 50-69 and 70 + age groups, significant declines of -4.1% and - 8.4% respectively were found. Excess declines were seen in clinical stage 0 and I in Mar-Jun, without excess increases in clinical stage II-IV tumors in Jul-Dec. There was no increase in average tumor diameter or nodal involvement in 2020. Patients diagnosed in Mar-Jun received significantly more neoadjuvant therapy, particularly neoadjuvant hormonal therapy for patients with clinical stage I-II BC. CONCLUSIONS BC incidence decline in 2020 in Belgium was largely restricted to very early-stage BC and patients aged 50 and over. Delayed diagnosis did not result in an overall progression to higher stage at diagnosis in 2020. Observed treatment adaptations in Belgium were successful in prioritizing patients for surgery while preventing tumor progression in those with surgical delay. Continuation of monitoring BC incidence and stage in the future is crucial.
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Affiliation(s)
- Hanna M Peacock
- Research Department, Belgian Cancer Registry, Koningsstraat 215 bus 7, Brussels, 1210, Belgium
| | - Lien van Walle
- Research Department, Belgian Cancer Registry, Koningsstraat 215 bus 7, Brussels, 1210, Belgium
| | - Geert Silversmit
- Research Department, Belgian Cancer Registry, Koningsstraat 215 bus 7, Brussels, 1210, Belgium
| | - Patrick Neven
- Department of Gynecological Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - Sileny N Han
- Department of Gynecological Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - Nancy Van Damme
- Research Department, Belgian Cancer Registry, Koningsstraat 215 bus 7, Brussels, 1210, Belgium.
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Pereyra L, Steinberg L, Lasa J, Marconi A, Calderwood AH, Pellisé M. Management of colorectal cancer screening backlog due to the COVID-19 pandemic: A retrospective analysis of the use of a colorectal cancer screening clinical-decision support tool in Argentina. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:140-148. [PMID: 36934841 PMCID: PMC10022173 DOI: 10.1016/j.gastrohep.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic created a backlog in colorectal cancer (CRC) screening and surveillance colonoscopies. The real impact in Argentina is not fully known. GOAL To estimate the impact of the COVID-19 pandemic on CRC prevention by comparing the number of CRC screening and surveillance consults in a clinical decision support-tool used in Argentina before, during and after pandemic lockdown. METHODS We analyzed data from May 2019 to December 2021 from CaPtyVa, a clinical decision support tool for CRC screening and surveillance. Queries were divided in pre-pandemic (May 2019 to March 2020), lockdown (April 2020 to December 2020), and post-lockdown (January 2021 to December 2021). The number of CRC monthly screening and surveillance visits were compared among the three periods and stratified according to CRC risk. RESULTS Overall, 27,563 consults were analyzed of which 9035 were screening and 18,528 were surveillance. Pre-pandemic, the median number of screening consults was 346 per month (IQR25-75 280-410). There was a decrease to 156 (80-210)/month (p<0.005) during lockdown that partially recovered during post-lockdown to 230 (170-290)/month (p=0.05). Pre-pandemic, the median number of surveillance consults was 716 (560-880)/month. They decreased to 354 (190-470)/month during lockdown (p<.05) and unlike screening, completely recovered during post-lockdown to 581 (450-790)/month. CONCLUSIONS There was a >50% decrease in the number of CRC screening and surveillance consults registered in CaPtyVa during lockdown in Argentina. Post-lockdown, surveillance consults recovered to pre-pandemic levels, but screening consults remained at 66% of pre-pandemic levels. This has implications for delays in CRC diagnoses and patient outcomes.
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Affiliation(s)
- Lisandro Pereyra
- Gastroenterology Department, Hospital Alemán, Buenos Aires, Argentina.
| | - Leandro Steinberg
- Gastroenterology Department, Hospital Durand, Buenos Aires, Argentina; Gastroenterology Department, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Juan Lasa
- Gastroenterology Department, Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina
| | | | - Audrey H Calderwood
- Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - María Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
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Amato O, Guarneri V, Girardi F. Epidemiology trends and progress in breast cancer survival: earlier diagnosis, new therapeutics. Curr Opin Oncol 2023; 35:612-619. [PMID: 37681462 PMCID: PMC10566595 DOI: 10.1097/cco.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW In this review we will critically appraise the latest evidence on breast cancer (BC) survival trends and discuss how these may reflect breakthroughs in early diagnosis and treatment approaches. We will address the wide global inequalities in BC survival and review the ongoing initiatives aimed at improving cancer control worldwide. RECENT FINDINGS BC outcomes have improved in high-income countries during the last decades, following the implementation of strategies for early detection and optimal multimodality treatment. Novel therapeutics, such as anti-HER2 targeted treatments, have also contributed to the progress in BC survival. However, BC mortality is still high in low-income countries, due to the lack of optimal healthcare infrastructures. In the context of marked inequities in BC management across world regions, international collaborations such as the Global Breast Cancer Initiative and the Global Initiative for Cancer Registry Development work to foster capacity-building in developing countries, tackle the burden of BC and deliver the Sustainable Development Goals by 2030. SUMMARY Collection of robust, high-quality data from population-based cancer registries is crucial to drive and refine public health interventions. Population-based data are also the litmus paper to evaluate the real-world impact of clinical advances and monitor progress.
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Affiliation(s)
- Ottavia Amato
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - Fabio Girardi
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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Malmgren JA, Guo B, Atwood MK, Hallam P, Roberts LA, Kaplan HG. COVID-19 related change in breast cancer diagnosis, stage, treatment, and case volume: 2019-2021. Breast Cancer Res Treat 2023; 202:105-115. [PMID: 37584882 PMCID: PMC10504101 DOI: 10.1007/s10549-023-06962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/26/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Evaluate the COVID-19 pandemic impact on breast cancer detection method, stage and treatment before, during and after health care restrictions. METHODS In a retrospective tertiary cancer care center cohort, first primary breast cancer (BC) patients, years 2019-2021, were reviewed (n = 1787). Chi-square statistical comparisons of detection method (patient (PtD)/mammography (MamD), Stage (0-IV) and treatment by pre-pandemic time 1: 2019 + Q1 2020; peak-pandemic time 2: Q2-Q4 2020; pandemic time 3: Q1-Q4 2021 (Q = quarter) periods and logistic regression for odds ratios were used. RESULTS BC case volume decreased 22% in 2020 (N = 533) (p = .001). MamD declined from 64% pre-pandemic to 58% peak-pandemic, and increased to 71% in 2021 (p < .001). PtD increased from 30 to 36% peak-pandemic and declined to 25% in 2021 (p < .001). Diagnosis of Stage 0/I BC declined peak-pandemic when screening mammography was curtailed due to lock-down mandates but rebounded above pre-pandemic levels in 2021. In adjusted regression, peak-pandemic stage 0/I BC diagnosis decreased 24% (OR = 0.76, 95% CI: 0.60, 0.96, p = .021) and increased 34% in 2021 (OR = 1.34, 95% CI: 1.06, 1.70, p = .014). Peak-pandemic neoadjuvant therapy increased from 33 to 38% (p < .001), primarily for surgical delay cases. CONCLUSIONS The COVID-19 pandemic restricted health-care access, reduced mammography screening and created surgical delays. During the peak-pandemic time, due to restricted or no access to mammography screening, we observed a decrease in stage 0/I BC by number and proportion. Continued low case numbers represent a need to re-establish screening behavior and staffing.
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Affiliation(s)
- Judith A Malmgren
- HealthStat Consulting, Inc, 12025 9th Ave NW, Seattle, WA, 98177, USA.
- School of Public Health, University of Washington, Seattle, WA, USA.
| | - Boya Guo
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Mary K Atwood
- Swedish Cancer Institute, 1221 Madison St, Seattle, WA, 98104, USA
| | - Paula Hallam
- Swedish Cancer Institute, 1221 Madison St, Seattle, WA, 98104, USA
| | - Laura A Roberts
- Swedish Cancer Institute, 1221 Madison St, Seattle, WA, 98104, USA
| | - Henry G Kaplan
- Swedish Cancer Institute, 1221 Madison St, Seattle, WA, 98104, USA
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Lee R, Xu W, Dozier M, McQuillan R, Theodoratou E, Figueroa J. A rapid review of COVID-19's global impact on breast cancer screening participation rates and volumes from January to December 2020. eLife 2023; 12:e85680. [PMID: 37698273 PMCID: PMC10569787 DOI: 10.7554/elife.85680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/20/2023] [Indexed: 09/13/2023] Open
Abstract
COVID-19 has strained population breast mammography screening programs that aim to diagnose and treat breast cancers earlier. As the pandemic has affected countries differently, we aimed to quantify changes in breast screening volume and uptake during the first year of COVID-19 . We systematically searched Medline, the World Health Organization (WHO) COVID-19 database, and governmental databases. Studies covering January 2020 to March 2022 were included. We extracted and analyzed data regarding study methodology, screening volume, and uptake. To assess for risk of bias, we used the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Twenty-six cross-sectional descriptive studies (focusing on 13 countries/nations) were included out of 935 independent records. Reductions in screening volume and uptake rates were observed among eight countries. Changes in screening participation volume in five nations with national population-based screening ranged from -13 to -31%. Among two countries with limited population-based programs, the decline ranged from -61 to -41%. Within the USA, population participation volumes varied ranging from +18 to -39%, with suggestion of differences by insurance status (HMO, Medicare, and low-income programs). Almost all studies had high risk of bias due to insufficient statistical analysis and confounding factors. The extent of COVID-19-induced reduction in breast screening participation volume differed by region and data suggested potential differences by healthcare setting (e.g., national health insurance vs. private healthcare). Recovery efforts should monitor access to screening and early diagnosis to determine whether prevention services need strengthening to increase the coverage of disadvantaged groups and reduce disparities.
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Affiliation(s)
- Reagan Lee
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Wei Xu
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Marshall Dozier
- Information Services, University of EdinburghEdinburghUnited Kingdom
| | - Ruth McQuillan
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Evropi Theodoratou
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Jonine Figueroa
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteBethesdaUnited States
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Olesen TB, Jensen H, Møller H, Jensen JW, Andersen B, Vejborg I, Njor SH. Nationwide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study. eLife 2023; 12:e83541. [PMID: 37589381 PMCID: PMC10513477 DOI: 10.7554/elife.83541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
Background In most of the world, the mammography screening programmes were paused at the start of the pandemic, whilst mammography screening continued in Denmark. We examined the mammography screening participation during the COVID-19 pandemic in Denmark. Methods The study population comprised all women aged 50-69 years old invited to participate in mammography screening from 2016 to 2021 in Denmark based on data from the Danish Quality Database for Mammography Screening in combination with population-based registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of mammography screening participation within 90, 180, and 365 d since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation. Results The study comprised 1,828,791 invitations among 847,766 women. Before the pandemic, 80.2% of invitations resulted in participation in mammography screening within 90 d, 82.7% within 180 d, and 83.1% within 365 d. At the start of the pandemic, the participation in screening within 90 d was reduced to 69.9% for those invited in pre-lockdown and to 76.5% for those invited in first lockdown. Extending the length of follow-up time to 365 d only a minor overall reduction was observed (PR = 0.94; 95% CI: 0.93-0.95 in pre-lockdown and PR = 0.97; 95% CI: 0.96-0.97 in first lockdown). A lower participation was, however, seen among immigrants and among women with a low income. Conclusions The short-term participation in mammography screening was reduced at the start of the pandemic, whilst only a minor reduction in the overall participation was observed with longer follow-up time, indicating that women postponed screening. Some groups of women, nonetheless, had a lower participation, indicating that the social inequity in screening participation was exacerbated during the pandemic. Funding The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.
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Affiliation(s)
- Tina Bech Olesen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Henry Jensen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Henrik Møller
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Jens Winther Jensen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional HospitalRandersDenmark
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
| | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University HospitalCopenhagenDenmark
| | - Sisse H Njor
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional HospitalRandersDenmark
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
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Worthington J, van Wifferen F, Sun Z, de Jonge L, Lew JB, Greuter MJ, van den Puttelaar R, Feletto E, Lansdorp-Vogelaar I, Coupé VM, Ein Yong JH, Canfell K. Potential global loss of life expected due to COVID-19 disruptions to organised colorectal cancer screening. EClinicalMedicine 2023; 62:102081. [PMID: 37538541 PMCID: PMC10393619 DOI: 10.1016/j.eclinm.2023.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background Screening for colorectal cancer (CRC) decreases cancer burden through removal of precancerous lesions and early detection of cancer. The COVID-19 pandemic has disrupted organised CRC screening programs worldwide, with some programs completely suspending screening and others experiencing significant decreases in participation and diagnostic follow-up. This study estimated the global impact of screening disruptions on CRC outcomes, and potential effects of catch-up screening. Methods Organised screening programs were identified in 29 countries, and data on participation rates and COVID-related changes to screening in 2020 were extracted where available. Four independent microsimulation models (ASCCA, MISCAN-Colon, OncoSim, and Policy1-Bowel) were used to estimate the long-term impact on CRC cases and deaths, based on decreases to screening participation in 2020. For countries where 2020 participation data were not available, changes to screening were approximated based on excess mortality rates. Catch-up strategies involving additional screening in 2021 were also simulated. Findings In countries for which direct data were available, organised CRC screening volumes at a country level decreased by an estimated 1.3-40.5% in 2020. Globally, it is estimated that COVID-related screening decreases led to a deficit of 7.4 million fewer faecal screens performed in 2020. In the absence of any organised catch-up screening, this would lead to an estimated 13,000 additional CRC cases and 7,900 deaths globally from 2020 to 2050; 79% of the additional cases and 85% of additional deaths could have been prevented with catch-up screening, respectively. Interpretation COVID-19-related disruptions to screening will cause excess CRC cases and deaths, but appropriately implemented catch-up screening could have reduced the burden by over 80%. Careful management of any disruption is key to improving the resilience of colorectal cancer screening programs. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Cancer Council New South Wales, Health Canada, and Dutch National Institute for Public Health and Environment.
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Affiliation(s)
- Joachim Worthington
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
| | - Francine van Wifferen
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Zhuolu Sun
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
| | - Marjolein J.E. Greuter
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Veerle M.H. Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
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Sadeghi A, Asadzadeh Aghdaei H, Khalafi MA, Nazemalhosseini-Mojarad E, Ketabi Moghadam P, Sohrabi MR. The impact of COVID-19 on national program of colorectal cancer screening in Tehran, Iran: a multicenter study. BMC Cancer 2023; 23:627. [PMID: 37407931 DOI: 10.1186/s12885-023-11111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected all aspects of the healthcare system, including prevention, treatment, rehabilitation of diseases and health education; access to essential therapies; allocation of finance & facilities to health issues, and governance of diseases, including COVID-19 and other diseases. Consequently, the burden of COVID-19 was not only attributable to the multiorgan involvement and detailed presentation of the disease but also to the inadequate management of other diseases resulting from the exclusive allocation of resources and medical personnel to the pandemic crisis. Over the mentioned period, one observed deficiency was the lack of public and official favor for conventional screening protocols. To this end, this study aims to evaluate the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening protocols at Shahid Beheshti University of Medical Sciences in Tehran, Iran, in an effort to identify individuals at risk for CRC and provide them with intensive screening and therapy. METHODS This is an observational study comparing the number of candidates for CRC screening referred to primary, secondary, and tertiary health-care centers under supervision of Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran in a 2-year interval before and after COVID-19 pandemics. Patients with intermediate- and high-risk criteria for colorectal cancer were included in the study and were screened by fecal immunochemical test. Patients with positive or indeterminate fecal test results were further evaluated with colonoscopy in research institute for gastroenterology and liver diseases where is a tertiary referral center for CRC screening. Finally, the decrease percentage of screening tests and endoscopic findings during the pandemic period compared to pre-pandemic period was calculated and interpreted. RESULTS A significant decrease in the number of performed fecal immunochemical tests (FITs), referred positive FITs, and referred patients with positive alarm signs to the Research Institute of Gastroenterology and Liver Diseases (RIGLD) center inevitably led to a considerable decrease in the number of endoscopic findings, including high-risk adenomas, sessile serrated polyps, and even early-stage colorectal cancers (CRCs). CONCLUSION The disruption of screening protocols caused by the COVID-19 pandemic appears to increase the number of patients with high-grade and end-stage CRCs referred in the near future.
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Affiliation(s)
- Amir Sadeghi
- Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences (SBMU), Taleghani Hospital, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences (SBMU), Taleghani Hospital, Tehran, Iran
| | - Mohammad Amin Khalafi
- Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences (SBMU), Taleghani Hospital, Tehran, Iran
| | - Ehsan Nazemalhosseini-Mojarad
- Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences (SBMU), Taleghani Hospital, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences (SBMU), Taleghani Hospital, Tehran, Iran.
| | - Mohammad-Reza Sohrabi
- Community Medicine Department, School of Medicine, Shahid Beheshti Medical University, Tehran, Iran
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10
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Bharwani A, Li D, Vermund SH. A Review of the Effect of COVID-19-Related Lockdowns on Global Cancer Screening. Cureus 2023; 15:e40268. [PMID: 37448422 PMCID: PMC10336183 DOI: 10.7759/cureus.40268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
COVID-19 lockdowns have led to significant disruptions in preventative health services worldwide. This review aims to assess the impact of COVID-19 lockdowns on worldwide preventive cancer screening participation. Major medical databases were searched using the keywords 'lockdown,' 'cancer,' and 'screening or diagnosis,' and relevant articles were evaluated against inclusion and exclusion criteria. The final review consisted of 38 studies. The impact of COVID-19 on screening uptake was categorized based on cancer type. All types of screening had decreased participation during or around the lockdown period. Racial and socioeconomic disparities, provider-related barriers, and patient attitudes about service disruptions during the pandemic were also highlighted in this review. Future research should focus on data from low- and middle-income countries to obtain a more comprehensive picture of the problem. Policy interventions that adopt self-screening or different screening intervals can also be considered to reduce impacts in future crises. Insights from existing studies and future research will allow for more proactive measures to manage future disruptions.
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Affiliation(s)
| | - Dan Li
- Public Health, Yale University, New Haven, USA
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11
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Toes-Zoutendijk E, de Jonge L, van Iersel CA, Spaander MCW, van Vuuren AJ, van Kemenade F, Ramakers CR, Dekker E, Nagetaal ID, van Leerdam ME, Lansdorp-Vogelaar I. Impact of delayed screening invitations on screen-detected and interval cancers in the Dutch colorectal cancer screening programme: individual-level data analysis. Gut 2023:gutjnl-2022-328559. [PMID: 37076272 DOI: 10.1136/gutjnl-2022-328559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/26/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To assess the impact of delayed invitation on screen-detected and interval colorectal cancers (CRC) within a faecal immunochemical testing (FIT)-based CRC screening programme. DESIGN All individuals that participated in 2017 and 2018 with a negative FIT and were eligible for CRC screening in 2019 and 2020 were included using individual-level data. Multivariable logistic regression analyses were used to assess the association between either the different time periods (ie, 'before', 'during' and 'after' the first COVID-19 wave) or the invitation interval on screen-detected and interval CRCs. RESULTS Positive predictive value for advanced neoplasia (AN) was slightly lower during (OR=0.83) and after (OR=0.92) the first COVID-19 wave, but no significant difference was observed for the different invitation intervals. Out of all individuals that previously tested negative, 84 (0.004%) had an interval CRC beyond the 24 months since their last invitation. The time period of invitation as well as the extended invitation interval was not associated with detection rates for AN and interval CRC rate. CONCLUSION The impact of the first COVID-19 wave on screening yield was modest. A very small proportion of the FIT negatives had an interval CRC possibly due to an extended interval, which potentially could have been prevented if they had received the invitation earlier. Nonetheless, no increase in interval CRC rate was observed, indicating that an extended invitation interval up to 30 months had no negative impact on the performance of the CRC screening programme and a modest extension of the invitation interval seems an appropriate intervention.
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Affiliation(s)
| | - Lucie de Jonge
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Manon C W Spaander
- Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anneke J van Vuuren
- Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Evelien Dekker
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Monique E van Leerdam
- Gastroenterology and Hepatology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Gastro-Intestinal Oncoloy, Leiden University Medical Center, Leiden, The Netherlands
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12
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Li T, Nickel B, Ngo P, McFadden K, Brennan M, Marinovich ML, Houssami N. A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis. Breast 2023; 67:78-88. [PMID: 36646004 PMCID: PMC9813855 DOI: 10.1016/j.breast.2023.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast cancer care has been affected by the COVID-19 pandemic. This systematic review aims to describe the observed pandemic-related changes in clinical and health services outcomes for breast screening and diagnosis. METHODS Seven databases (January 2020-March 2021) were searched to identify studies of breast cancer screening or diagnosis that reported observed outcomes before and related to the pandemic. Findings were presented using a descriptive and narrative approach. RESULTS Seventy-four studies were included in this systematic review; all compared periods before and after (or fluctuations during) the pandemic. None were assessed as being at low risk of bias. A reduction in screening volumes during the pandemic was found with over half of studies reporting reductions of ≥49%. A majority (66%) of studies reported reductions of ≥25% in the number of breast cancer diagnoses, and there was a higher proportion of symptomatic than screen-detected cancers. The distribution of cancer stage at diagnosis during the pandemic showed lower proportions of early-stage (stage 0-1/I-II, or Tis and T1) and higher proportions of relatively more advanced cases than that in the pre-pandemic period, however population rates were generally not reported. CONCLUSIONS Evidence of substantial reductions in screening volume and number of diagnosed breast cancers, and higher proportions of advanced stage cancer at diagnosis were found during the pandemic. However, these findings reflect short term outcomes, and higher-quality research examining the long-term impact of the pandemic is needed.
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Affiliation(s)
- Tong Li
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Preston Ngo
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kathleen McFadden
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Meagan Brennan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Allahqoli L, Mazidimoradi A, Salehiniya H, Alkatout I. Impact of COVID-19 on cancer screening: a global perspective. Curr Opin Support Palliat Care 2022; 16:102-109. [PMID: 35862881 PMCID: PMC9451605 DOI: 10.1097/spc.0000000000000602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Cancer screening disruption due to COVID-19 may have a significant impact on patients, healthcare practitioners, and healthcare systems. In this present review, we aim to offer a comprehensive view of the effect of the COVID-19 pandemic on cancer screening programs worldwide. RECENT FINDINGS The present review comprised 33 publications. During the COVID-19 pandemic, the rates of cancer screening investigations were drastically reduced worldwide. Screening rates plummeted for all types of cancer, all ages, and racial/ethnic groups. Reductions in screening percentages were higher in several underserved racial groups. Cancer screening was suspended for at least 30 days in 13 countries. SUMMARY Screenings for all types of cancer fell sharply. In the chain of cancer management, delays in any step are liable to change the outcome of the next step. Further long-term research will be needed to fully comprehend the impact of the pandemic on cancer services and patient outcomes.
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Affiliation(s)
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Kiel, Germany
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14
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Domper-Arnal MJ, Hijos-Mallada G, Lanas Á. The impact of COVID-19 pandemic in the diagnosis and management of colorectal cancer patients. Therap Adv Gastroenterol 2022; 15:17562848221117636. [PMID: 36035306 PMCID: PMC9403473 DOI: 10.1177/17562848221117636] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to healthcare systems worldwide, causing downscaling of almost all other activities, especially in its early stages. Currently, the availability of vaccines along with the spread of new viral variants has modified the epidemiology of the disease, and the previous activity is being gradually resumed in most healthcare facilities. In this review, we have summarized the influence of the COVID-19 pandemic in the diagnosis and management of colorectal cancer (CRC) patients. Population-based screening with either colonoscopy or fecal occult blood tests has proven to reduce CRC incidence and mortality, so screening programs have been implemented in most western countries. However, during the first COVID-19 wave, most of these programs had to be disrupted temporarily. In this review, we have thoroughly analyzed the consequences of these disruptions of screening programs as well as of the forced delays in diagnostic and therapeutic services on CRC prognosis, although its exact impact cannot be exactly measured yet. In any way, strategies to minimize its effect, such as catch-up strategies expanding the colonoscopy capacity or using fecal occult blood concentration and other risk factors to prioritize patients, are urgently needed. The COVID-19 pandemic has also led to a change in CRC patient presentation, with an overall temporary decreased incidence due to postponed diagnoses, but with more patients presenting in need of an emergency admission or with symptoms. Finally, changes in treatment approaches in CRC patients have been reported during the pandemic, namely a drop in the proportion of laparoscopic surgeries or a rise in short-term radiotherapy courses. We have therefore aimed to summarize the available evidence to guide the healthcare professionals treating CRC patients to choose the best treatment options in the current pandemic situation.
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Affiliation(s)
| | | | - Ángel Lanas
- Service of Digestive Diseases, University
Clinic Hospital, Zaragoza, Spain,Aragón Health Research Institute (IIS Aragón),
Zaragoza, Spain,CIBERehd, Madrid, Spain,University of Zaragoza, Zaragoza, Spain
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15
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Self-Reported and Objective Impact of the COVID-19 Pandemic on Planning, Compliance and Timeliness of a Diagnostic Colonoscopy after a Positive FIT Screening Result in the Flemish Colorectal Cancer Screening Program. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4030013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: During the COVID-19 pandemic, the Flemish colorectal cancer (CRC) screening program (by fecal immunochemical test, FIT) was suspended and non-urgent medical procedures were discommended. This study estimates how this impacted diagnostic colonoscopy (DC) scheduling after a positive FIT and the interval between both in 2020. Methods: An online survey was sent to participants in the Flemish CRC screening program with a positive FIT but without a DC to explore the possible impact of COVID-19 on the scheduling of a DC. Self-reported survey results were complemented with objective data on DC compliance and the interval between FIT and DC. Results: In 2020, DC compliance was 4–5% lower than expected (for 3780 positive FITs no DC was performed). In February–March 2020, the median time between a positive FIT and DC significantly increased. Survey participants reported fear of COVID-19 contamination, perception to create hospital overload, delay in non-urgent medical procedures (on government advice) and not being sure a DC could be performed as contributing reasons. Conclusions: On top of a 3% lower participation, the COVID-19 pandemic further increased existing DC non-compliance and the positive FIT–DC interval. The survey confirmed the crucial role of COVID-19 in the decision not to plan a DC.
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