Cancer experts are warning that it “might be some time” before cancer services return to levels seen before the Covid-19 pandemic, but it’s important to “make up for lost ground.”
In a new report, researchers detail the drop in cancer screenings and subsequent diagnoses that occurred in the United States during the early days of the Covid-19 pandemic, and indicate that the data trigger concerns about cancer outcomes in the coming years.
The report, published Wednesday in the journal Cancer, provides more evidence that in the first calendar year of the Covid-19 pandemic, there were significant declines in the number of newly diagnosed cases of six major cancers: colorectal, female breast, lung, pancreas, prostate and thyroid. Those declines can be attributed to many people canceling or postponing cancer screenings while staying home during the pandemic, which can subsequently delay a diagnosis or care.
“Suspension of cancer‐related procedures has created a backlog of health services, such as increasing wait times for cancer surgery,” researchers from the National Cancer Institute, the US Centers for Disease Control and Prevention, the American Cancer Society and other US institutions wrote in the new report.
“Despite the Biden administration’s plan to declare the public health emergency over on May 11, 2023, it might be some time before cancer services return to prepandemic volumes,” the researchers wrote.
At the beginning of the pandemic, nearly 10 million cancer screenings were estimated to have been missed, said Dr. Lisa Richardson, director of the CDC’s Division of Cancer Prevention and Control.
“But now it’s time for you to come back in to get these things done,” Richardson said about the importance of resuming routine health care, including cancer screenings. “Cancer doesn’t wait, neither should you.”
She added that even with a return to prepandemic levels of people completing screenings and other cancer services, those nearly 10 million people who missed screenings previously still need to be “caught up.”
When that happens, “what we might see is that there are actually more cases of cancer, because people caught up,” she said “But it’s not truly an increase. It’s just a catch up of what was there that we didn’t diagnose during 2020.”
‘We are deeply concerned’
For the new report, the researchers analyzed data on new cancer diagnoses that were reported between 2015 and 2020. The data came from the North American Association of Central Cancer Registries.
Also, the researchers modeled how many cancer diagnoses typically would have been expected for those given years. They found that in 2020, there were fewer newly diagnosed cases than expected and April of that year had the “sharpest decrease in cases” compared with previous years, most likely because of the Covid-19 pandemic, according to the study.
The data showed that the volume of pathology reports decreased during that time as well in early 2020. Pathology reports are used by medical providers to determine a diagnosis or treatment plan for specific conditions, such as cancer.
“We are deeply concerned about the implications of delayed diagnosis, which is typically associated with more aggressive disease and worse outcomes,” Karen Knudsen, chief executive officer of the American Cancer Society, said in a news release. “It is imperative to ensure that we make up for lost ground on finding cancers early, and thereby maximize opportunities for effective treatment and survival.”
In the data, the researchers found some differences by age in newly diagnosed cancers. For colorectal, breast and prostate cases, the researchers found there were fewer diagnosed cases than expected among people 40 and older but not among people younger than 40.
“We don’t generally screen people under the age of 40, and I think that’s the main reason why we don’t see any changes there,” Richardson said.
Overall, the data showed that reported cases decreased abruptly starting in March 2020 and became most pronounced in April before improving minimally in May.
“Subsequently, for most cancer types, the deficit decreased in June and generally was not measurable in the second half of 2020. Furthermore, we report some evidence of a rebound effect for certain cancer types, although the rebound did not offset the deficit in the first one half of the year,” the researchers wrote in their study.
The report’s findings align with previous studies indicating significant decreases in the prevalence of cancer screenings during the Covid-19 pandemic, and the importance of now resuming screenings as well as routine care.
A previous study from the American Cancer Society, released in February, found that between 2019 and 2021, the overall prevalence of eligible adults who completed screening in the previous year fell 6% for breast cancer, 15% for cervical cancer and 10% for prostate cancer.
But more recently, it appears that people are starting to return to routine screenings at rates seen before the pandemic, according to separate data published in February in the journal Epic Research, which is owned by the health care software company Epic.
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“As screening rates returned to normal from the drop we previously reported, rates of cancer diagnosis returned to normal as well,” Dr. Chris Alban, a clinical informaticist at Epic Research, wrote in an email in February.
“We haven’t seen evidence that the screenings missed during the pandemic resulted in worsened patient outcomes, though we plan to monitor this trend to see whether it holds over time,” he said. “The recommended intervals between screenings for a given cancer can be several years, so evidence of advanced cancers can take a long time to appear.”
