Breast, Cervical and Colorectal Cancer Screening Rates – Before and After the Pandemic

Although we no longer discuss it as much as before, many wounds from the COVID-19 pandemic remain unhealed. One involves serious disruption to cancer screening for early diagnosis.

JAMA Oncology published a cross-sectional US study by Allison Oakes and colleagues on 17 November 2022. They found that, as of December 2021, breast, cervical and colorectal cancer screening rates had fallen sharply during the pandemic and, despite some subsequent recovery, remained below levels before the COVID-19 pandemic.

The study used nationwide US health records from January 2017 to December 2021.

Key Findings

The analysis included 306 million people with a mean age of 51.5.

For breast cancer, the median quarterly screening rate fell from 8,216 per 100,000 people before the pandemic to 4,951 per 100,000 in quarter 2 of 2020 (a 40% decline). Rates rose to pre-pandemic levels by quarters 3 and 4 of 2020, then fell to 7,374 per 100,000 in 2021, with quarterly deficits ranging from 6% to 17%. With fewer screenings, reported breast cancer incidence fell by approximately 6% between 2019 and 2020 and a further 5% between 2020 and 2021.

For cervical cancer, the median quarterly screening rate fell from 5,602/100,000 before the pandemic to 3,563/100,000 in quarter 2 of 2020 (a 36% decline). Rates rose to pre-pandemic levels by quarter 3 of 2020, then fell to 4,853/100,000 in quarter 4 of 2020 and 4,246/100,000 in quarter 4 of 2021. Reported cervical cancer incidence fell by approximately 6% between 2019 and 2020 and, with an additional increase, fell by about 5% between 2020 and 2021.

For colorectal (large bowel) cancer, the median quarterly screening rate fell from 3,162/100,000 before the pandemic to 1,746/100,000 in quarter 2 of 2020 (a 45% decline). From quarter 3 of 2020 to quarter 4 of 2021, quarterly rates ranged from 2,590 to 2,861/100,000, representing 82% to 90% of the pre-pandemic level. Reported colorectal cancer incidence fell by approximately 7% between 2019 and 2020 and a further 6% between 2020 and 2021.

Overall, this cross-sectional study shows that population-based screening and diagnosis rates for three major cancers remained below pre-pandemic levels. We expect the situation in our country to be similar. Even before the pandemic, public participation in cancer screening was far below ideal.

The findings show that screening recovered quickly after the early stages of the pandemic, but longer follow-up revealed that gaps in preventive cancer screening returned and worsened. The researchers' observation indicates that cancer screening had been neglected to a substantial degree through 2021. To reduce long-term adverse outcomes such as diagnosis at more advanced stages, multiple stakeholders need to evaluate new strategies and allocate appropriate resources to increase age- and sex-appropriate cancer screening.