Noninvasive Colorectal Cancer Screening Tests Help Close Screening Gaps During Coronavirus Disease 2019 Pandemic

Anthony Myint,Lily Roh,Liu Yang,Lynn Connolly,Eric Esrailian,Folasade P May

doi:10.1053/j.gastro.2021.04.026

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has upended routine preventive care across the country. Health systems worldwide have seen a drastic decrease in utilization of preventive care services, including colorectal cancer (CRC) screening.1 In response to the pandemic, the US Surgeon General advised in March 2020 that all hospitals and ambulatory surgical centers delay nonurgent surgeries and medical procedures, including screening and surveillance colonoscopies. In line with these recommendations, the University of California Los Angeles (UCLA) health system temporarily ceased elective endoscopies and purposefully encouraged the use of stool-based CRC screening modalities among patients and providers through weekly system-wide e-mails to primary care and gastroenterology providers, virtual meetings with primary care leadership, and standardized educational materials for fecal immunochemical testing (FIT).

Highlights

In the period before COVID-19, there was an average of 382.4 ± 54.8 screening tests per week, with colonoscopies (222.6 ± 33.0 per week) and fecal immunochemical testing (FIT) (154.0 ± 25.2 per week) comprising most tests
Flexible sigmoidoscopy and computed tomography colonography utilization remained low throughout the study period
To determine if providers intended to use FIT as an alternative to colonoscopy while access to colonoscopy was low or in addition to colonoscopy until the procedure was more available, we reviewed rates of subsequent colonoscopy for patients who had a negative FIT during our Abbreviations used in this paper: COVID-19, coronavirus disease 2019; CRC, colorectal cancer; FIT, fecal immunochemical testing

Summary

Introduction

Elective endoscopy ceased on March 18, 2020, at which time the health system implemented messaging to primary care and gastroenterology providers (eg, e-mail communication, virtual meetings) and continued mailed FIT2 to encourage stool-based CRC screening when clinically appropriate. We performed a retrospective analysis using electronic health record data to identify all UCLA primary care patients who completed an endoscopy (colonoscopy or flexible sigmoidoscopy), FIT, computed tomography colonography, or stool DNA screening test during the endoscopy cessation period (March 18, 2020 to May 4, 2020), during an equal time interval before the cessation (January 29, 2020 to March 17, 2020), and during the months after resumption of elective endoscopies (May 5, 2020 to October 27, 2020).

Results

Conclusion