Since the outbreak of COVID-19, the National Cancer Institute (NCI) and other experts have been raising concerns about patients not keeping their cancer screening appointments. This is particularly worrisome when a patient’s medical and/or family history place them in a high-risk category. The concern is that a percentage of these cancers won’t be detected until the later stages, when the disease is harder to treat and more expensive.
Because some cancers grow very slowly, their mortality rates won’t be known for several years, according to the NCI. In the meantime, many healthcare organizations have been tracking how COVID-19 impacted preventive screenings – and the results are telling.
In August 2021, University of Michigan physician and researcher Nora V. Becker, MD, PhD., published a study in the August issue of the JAMA Health Forum about the impacts of missed screenings on Women’s Health in 2020.¹ The study focused on preventive health services for women, an important category of care that when used in accordance with national guidelines improves reproductive health outcomes and reduces morbidity and mortality.
Becker used data from a large commercial insurance plan in Michigan to study five types of women’s preventive health services: breast cancer screenings (mammograms), cervical cancer screenings (PAP smears and HPV testing), sexually transmitted infection screening and two different types of contraceptives. Looking at how test results changed during the pandemic, from 2019 to 2020, the study found significant drops in services that required an in-person encounter, namely screenings for breast cancer and cervical cancer.
Breast and cervical cancer screenings showed dramatic decreases, dropping to 96.6% and 90.5%, respectively. According to Becker, patients who were up to date on their prior cancer screenings and rescheduled missed screenings within a year or so probably saw very little impact on their health. But those who were already behind on their recommended screenings or who didn’t reschedule their missed screenings in a timely fashion were at higher risk for future cancer diagnoses and morbidity due to the missed screenings.
Noting that her study was limited to a relatively small commercially insured population, Becker expressed concerns that people who are uninsured or on Medicaid would likely show an even greater percentage of missed screenings during the pandemic. According to Becker, underserved populations, including racial minorities, those with low incomes, and those who don’t speak English well, face enormous barriers and already have a much harder time accessing medical care than those who are commercially insured.
At the University of Cincinnati Cancer Center, researchers reported the pandemic caused “considerable disruption” to the lung cancer screening program in 2020. In March 2020, the pandemic forced more than 800 lung screening appointments to be postponed.² But according to researchers, when screenings resumed in June 2020, the percentage of test subjects who had lung nodules that were suspicious for cancer had increased from 8% to 29%.
In May 2020, a study published by the Epic Health Research Network indicated an abrupt and alarming drop in preventive cancer screenings performed in the U.S. from 2017 – 2020.³ Researchers assessed screenings for cervical, colon and breast cancer completed from a data set that included 2.7 million patient records from 39 organizations representing 190 hospitals in 23 states. They found that breast and cervical cancer screenings declined 94% in March 2020 compared to average figures from 2017 – 2019, while colorectal screenings fell 86% over the same period. Additionally, the study discovered a higher rate of canceled screening appointments before official stay-at-home orders were implemented and national medical societies recommended patients delay unessential outpatient care.
A study published in an August 2020 by JAMA Network Open shows a combined decrease of roughly 46% in new weekly diagnoses across six different cancers.⁴ According to researchers, the decline is not likely due to an organic decrease in the occurrence of these cancers, but rather a result of undetected cancers due to missed screenings.
As the battle against COVID-19 continues to ebb and flow, the healthcare industry is already scrambling to prepare its response to the next pandemic. With the right tools and platforms in place, hospitals and payers can aggregate data from disparate systems and standardize it in a way that allows them to swiftly identify high-risk patients for targeted outreach and follow-up. Optimizing data to help ensure patients keep their cancer screening appointments – before, during and after major global crises – is just one of the ways data curation and enrichment is helping improve outcomes, reduce costs and, ultimately, save lives.
¹JAMA Health Forum. Utilization of Women’s Preventive Health Services During the COVID-19 Pandemic. July 2, 2021. Link: 10.1001/jamanetworkopen.2020.17267
²Journal of the American College of Surgeons. Impact of the COVID-19 Pandemic on Lung Cancer Screening Program and Subsequent Lung Cancer. April 1, 2021. Vol. 232, Issue 4, pg. 600-605.
³Epic Health Research Network. Delayed Cancer Screenings. Abstract: COVID-19 weekly volumes for preventive cancer screenings for breast, colon, and cervical cancer are 86%-94% lower than 2017-2019 historical averages. May 4, 2020. Link: https://ehrn.org/articles/delays-in-preventive-cancer-screenings-during-covid-19-pandemic/
⁴JAMA Network Open. Changes in the Number of US Patients with Newly Identified Cancer Before and During the COVID-19 Pandemic. August 4, 2020. Link: 10.1001/jamanetworkopen.2020.17267