One of the more frustrating impacts of the Covid-19 pandemic was the dramatic reduction in access to routine cancer screenings like mammograms, colonoscopies, and Pap/HPV testing. When these services resumed following lockdowns, fear or other life circumstances, such as lack of insurance or caregiving duties, may have prevented many people from undergoing the screenings when they were due.

A recent study in JAMA Oncology noted that avoidance of non-urgent medical treatment and care, limited access to in-person medical examinations, and the reorganization of hospital departments were other factors that caused reductions in cancer screenings. Curiously, the invasive techniques used in colonoscopies and Pap/HPV tests were also cited as possible factors as well.

Remind Patients They Can Catch Up

The study calculated how many breast, colorectal, and cervical cancer screenings were missed through the first wave of the pandemic in 2020. Though the study does not calculate the screening percentages after 2020, it is likely that many of the missed screenings during that year were never obtained since rates did not increase over historical averages in late 2020. 

A newer study has assessed global cancer screening rates between January and October 2020. Based on the findings of 39 published studies, cervical cancer screening rates dropped 52% and breast cancer screening fell 47%. Colorectal screenings fell 45% which is split into a 52.5% decrease in colonoscopies and a 38% decrease in fecal occult blood tests or fecal immunochemical tests.

While it is too early to determine how many cancer cases resulted from missed screenings or how cancer rates might increase as a result of the pandemic, it is still possible to prevent more new cases from occurring by ensuring patients get the screenings they missed. Nurses, PAs, and other healthcare providers have the best opportunity to remind patients of the importance of screenings, even during an acute care visit. Clinicians can ask patients when their last screening was and remind them that they can schedule catch-up screenings that might have been missed during the pandemic. 

Biggest Drops During Lockdowns

Screening rates for all three cancer types showed the same U-shaped curve with a precipitous dip in April 2020 when pandemic restrictions were greatest and most widespread. That month, mammography was down 74% globally and 87% in North America but recovered between June and October. Colorectal cancer screenings were down 69% globally and 83% in North America. Colorectal screenings remained 23% lower between June and October.  In March 2020, cervical cancer screening rates hit their low at 79% below the average for the pre-pandemic period.

Though this specific study did not look at cancer diagnoses or death rates, the authors noted that the widely reduced screenings were “possibly associated with delayed diagnoses and increased cancer mortality.”  

The researchers also highlighted that their findings revealed “consistency of results across a wide spectrum of healthcare settings,” which supported their concern that the reduction in screenings could lead to increased cancer mortality while also burdening the healthcare system.

They noted, “the interruption of cancer screening could delay diagnosis of tumors, causing a shift to more advanced stages at diagnosis…Furthermore, this could be associated with increased avoidable cancer deaths, aggravate the patients’ discomfort and disease burden, and be associated with increased workload for medical personnel and increased costs for the healthcare system.” Since several screening recommendations stop at certain ages, the researchers cited that “a portion of the postponed screening tests could be impossible to recover because during the suspension some patients exceeded the maximum age to be included in screening programs.”

The U.S. Preventive Services Task Force recommends screening for these cancers as follows:

Breast Cancer Screening: 

• Women aged 50 to 74 years old should undergo screening every two years
• Women aged 40 to 49 should screen based on risk level and personal assessment of risk versus benefit.

These recommendations are aimed at the broader population of “asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation, such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome, or a history of chest radiation at a young age.” 

Cervical Cancer Screening: 

• Women, and other people with a cervix, aged 21 to 29 should be screened with cytology alone every 3 years. 
• People with a cervix aged 30 to 65 should be screened every 3 years with cytology alone or every 5 years with HPV testing, or every 5 years with HPV testing and cytology together. 
• Screening is not recommended in those under 21, over 65, or have had their cervix removed.

Colorectal Cancer Screening: 

• Adults aged 45 to 75 should undergo screenings with a frequency depending on the screening type:
• High-sensitivity guaiac fecal occult blood test (gFOBT) or fecal immunochemical tests (FIT) yearly
• Stool DNA fecal immunochemical test (sDNA-FIT) every 1 to 3 years
• CT colonography every 5 years
• Flexible sigmoidoscopy every 5 years
• Flexible sigmoidoscopy every 10 years, plus FIT year
• Colonoscopy screening every 10 years