Cancer Screenings and COVID-19: What a New Study Shows

COVID-19 continued to take a significant toll on cancer screenings during the second year of the pandemic, according to newly published findings from researchers with the American Cancer Society.

Based on data from the National Health Interview Survey, researchers compared past-year cancer screening prevalence, including breast, prostate, and cervical cancer screening, between 2019 and 2021. As per age-eligibility screening guidelines from the United States Preventive Services Task Force (USPSTF), the study authors reviewed survey responses from women 50 to 74 years of age in the breast cancer screening population, men 55 to 69 years of age in the prostate cancer screening cohort and women 21 to 65 years of age (without a hysterectomy) for the cervical cancer screening population.

In comparison to pre-pandemic numbers from 2019, the researchers found a 2.8 percent decrease in breast cancer screening in 2021 (59.9 percent vs. 57.1 percent), amounting to a 1.1 million decline. There was a 4.4 million decrease in cervical cancer screening (a decline of 6.3 percent) and a 600,000 decrease in prostate cancer screening (a decline of 3.2 percent) in 2021, according to the study, which was recently published in the Journal of Clinical Oncology.

“The declines in past-year screening prevalence for breast, cervical, and prostate cancer in 2021 compared with 2019 … suggest that screening prevalence in the United States have not fully returned, nor surpassed, the pre-pandemic levels after the onset of the COVID-19 pandemic,” wrote study co-author Ahmedin Jemal, D.V.M., Ph.D., a senior vice president of Surveillance and Health Equity Science with the American Cancer Society. “ … These declines have significant public health implications as they are expected to lead to more advanced stage cancer diagnosis in the future.”

Noting possible contributing factors such as language barriers, digital barriers, lack of trust in the health-care system and heightened racial discrimination during the pandemic, the researchers said the steepest cancer screening declines were found in the non-Hispanic Asian-American population. The study authors noted 13.8 percent, 10.1 percent and 18.7 percent declines in breast cancer screening, cervical cancer screening, and prostate cancer screening, respectively, for non-Hispanic Asian-Americans.

“These findings are especially concerning as cancer is the leading cause of death in both Asian American men and women, and (non-Hispanic) Asians are among a racialized group with low screening uptake,” noted Jemal and colleagues.

(Editor’s note: For related content, see “Mammography Screening Intervals and DCIS: What a New Study Reveals,” “COVID-19 and Cancer: What a New Chest CT Study Reveals” and “Study Suggests the COVID-19 Pandemic Led to Millions of Decreased Cancer Screenings.”)

The researchers did note an uptick in 4th quarter past-year cancer screenings in 2021 with breast cancer screening nearly equivalent (59.7 percent) to pre-pandemic prevalence in 2019 (59.8 percent) and prostate cancer prevalence (43.2 percent) surpassing 4th quarter prevalence reported in 2019 (41.3 percent).

In regard to the study’s emphasis on past-year screening, the authors acknowledged that survey responses from the first quarter of 2021 may have reflected cancer screening experience prior to pandemic-related closures of health-care facilities that began in April 2020. Jemal and colleagues also pointed out a higher income among 2021 survey respondents in comparison to those from 2019. Noting that higher socioeconomic status is associated with increased cancer screening, the study authors said this finding may have contributed to a reduced decline in breast cancer and cervical cancer screenings in 2021.