Breast, colorectal, and cervical cancer screening was reduced during the COVID-19 pandemic as compared to pre-COVID time periods.

1. All cancer types had the greatest decrease in screening during the early part of the pandemic.

2. Europe had a greater decrease in both colorectal and breast cancer screening than North America.

Evidence Rating Level: 2 (Good)

Study Rundown: The COVID-19 pandemic has affected screening tests for cancer worldwide. This systematic review and meta-analysis aimed to compare the number of breast, cervical, and colorectal cancer screenings before and during the pandemic. The primary outcome of interest was the weighted average percentage variation from before and during the pandemic. For breast cancer screening during the pandemic, the average variation was -46.7% between January to October, 2020 as compared to the pre-COVID period, with the greatest decrease during April 2020. For colorectal cancer, there was a 44.9% decrease in screening exams performed during the COVID time period as compared to pre-COVID period, similarly with a greatest decrease during April 2020. The weighted average variation for cervical cancer was -51.8% during the pandemic, and the greatest decrease was during March 2020. For all cancer types, the greatest decrease in screening was during the early part of the pandemic in 2020. Europe was found to have a greater decrease in both colorectal and breast cancer screening than in North America. South America had a greater percentage variation than in North America. Limitations to this study include heterogeneity between countries for a variety of factors that could not all be accounted for in the statistical analysis. Additionally, there is the potential of a nondifferential misclassification bias due to the methods of allocating observation data to one of the 5 time periods. Overall, the pandemic resulted in a decrease in screening efforts during the pandemic as compared to before the pandemic.

Click to read the study in JAMA Oncology

Relevant Reading: Cancer screening and early detection in the 21st century

In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis included 39 publications of observational studies and cancer registry articles that were obtained from a variety of databases and included data collected worldwide. Only studies that compared the pre-COVID time period with a period during COVID were included. The weighted average variation for breast cancer was -46.7% (95% confidence interval (CI), -55.5% to -37.8%) during the COVID-19 pandemic, as compared to before. For colorectal cancer it was -44.9% decrease during the COVID time period as compared to pre-COVID (95% CI, -53.8 to -36.1). Cervical cancer screening saw a similar reduction in weighted average variation at -51.8% (95% CI, -64.7% to -38.9%) during the pandemic, compared to before. Additionally, both Europe and South America had a greater decrease in breast cancer screening, compared to North America (-35.6% (95%CI, -65.9% to -5.3%) and -2.8% (95%CI, -20.9% to 15.3%), respectively). This was similar for cervical cancer between South America and North America (-11.6% (95%CI, -34.5% to 11.3%). Finally, colorectal cancer screening was decreased in Europe as compared to North America (-12.3% (95%CI, -30.3% to 5.7%), and the results for Asia were 12.2% (95%CI, -13.9% to 38.4%).

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