Rates of routine cancer screening compared with pre-pandemic levels.

Abstract

10573 Background: The COVID-19 pandemic caused significant disruptions to healthcare delivery in the US due to mandatory stay-at-home orders and patient fears about visiting healthcare facilities. A logical consequence, many forms of healthcare use, including cancer screenings, sharply decreased in early 2020. Early studies suggest that cancer screening rebounded through the summer of 2020; however, > 2 years removed from the start of the pandemic, the long-term impact of missed screenings is unknown. The objective of this study was to examine trends in breast, cervical, and colorectal cancer screening from 2017-2022. Methods: This cross-sectional study used the Trilliant Health national all-payer claims database to analyze calendar year quarterly medical claims from Q1 2017- Q2 2022. We limited the study sample to those aged 21-85, the guideline-concordant target populations for the screening procedures. For breast and cervical cancer, we limited our sample to women. Using Current Procedural Terminology (CPT) codes, we calculated the quarterly number of individuals, per 100,000 eligible beneficiaries, who received screening for breast cancer, cervical cancer, and colorectal cancer. Percentage change in screening tests was compared. Results: In total, the analysis included > 300M unique individuals. For breast cancer, the median quarterly rate of pre-pandemic screening mammography was 8013 per 100k beneficiaries, which declined to 4,884 in Q2 of 2020—a 39% decrease. Screening mammography rebounded to pre-pandemic levels by Q3 and Q4 of 2020 but declined to a median rate of 7,314 per 100,000 beneficiaries in Q2 2022, with quarterly deficits ranging from 4-16%. For cervical cancer, the median quarterly rate of pre-pandemic screening was 5,469 per 100k beneficiaries. The rate of cervical cancer screening fell to 3,550 in Q2 of 2020—a 35% decline. By Q3 2020, cervical cancer screening rebounded toward the pre-pandemic median, then progressively declined to 4,557 per 100k beneficiaries by Q2 2022. Over the same time period, colorectal cancer screening decreased from a pre-pandemic median of 3,111 per 100k beneficiaries to 1,731 in Q2 of 2020—a 44% difference. From Q3 2020 to Q1 2022, the quarterly colorectal cancer screening rate remained 10-17% below pre-pandemic levels, but returned to 3,047 per 100k in Q2 2022, only 2% below the pre-pandemic median. Conclusions: Across the three studied cancer types, population-based screening remains below pre-pandemic levels. In agreement with other research, we find that screening quickly rebounded following the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened. Underutilization of recommended cancer screenings will likely result in an increase in later-stage initial diagnoses and excess mortality from cancer in the future.