Abstract
The COVID-19 pandemic has affected many healthcare services worldwide. Like many other nations, the Netherlands experienced large numbers of individuals affected by COVID-19 in 2020, leading to increased demands on hospitals and intensive care units. The Dutch Ministry of Health decided to suspend the Dutch biennial fecal immunochemical test (FIT) based colorectal cancer (CRC) screening program from March 16, 2020. FIT invitations were resumed on June 3. In this study, we describe the short-term effects of this suspension on a myriad of relevant screening outcomes. As a result of the suspension, a quarter of the individuals due for screening between March and November 2020 had not received their invitation for FIT screening by November 30, 2020. Furthermore, 57.8% of those who received a consecutive FIT between the restart and November 30, 2020, received it outside the upper limit of the standard screening interval (26 months). Median time between positive FIT and colonoscopy did not change as a result of the pandemic. Participation rates of FIT screening and follow-up colonoscopy in the months just before and during the suspension were significantly lower than expected, but returned to normal levels after the suspension. Based on the anticipated 2020 cohort size, we estimate that the number of individuals with advanced neoplasia currently detected up until November 2020 was 31.2% lower compared to what would have been expected without a pandemic. Future studies should monitor the impact on long-term screening outcomes as a result of the pandemic.
Highlights
The COVID-19 pandemic is having a profound impact worldwide
To prevent overburdening of health systems and to ensure the safety of health care workers and patients, a lot of non-urgent health care worldwide was curtailed during the spring of 2020, including colonoscopies in colorectal cancer (CRC) screening programs.(Parasa et al, 2020) Likewise, the CRC screening program using a fecal immunochemical test (FIT) in the Netherlands was temporarily suspended for 11 weeks from March 16, 2020
Based on an increase in available colonoscopy capacity and declining COVID-19 hospitalization rates, the decision was made on May 11 that there would be a phased restart of the screening program according to the first-in-first-out principle
Summary
The COVID-19 pandemic is having a profound impact worldwide. As of May 2021, over three million individuals have died from COVID-19 worldwide despite the implementation of rigorous regional and na tional measures to prevent infection (e.g. (partial) lockdowns, facial mask requirements, and contact tracing).(Dong et al, 2020; Hale et al, 2020) Many other patients with COVID-19 required hospitalization, including admission to intensive care units, which is challenging the provision of regular health care. Individuals due for screening during the suspension did not receive their expected invitation until June 2020 or later. This may have led to increased intervals between two subsequent screening invitations or a delayed start of screening for those invited for the first time. In this study based on data from the Dutch CRC screening registry, we aimed to assess the short-term impact of the suspension of the Dutch CRC screening program due to the first wave of COVID-19 cases on various screening outcomes, including screening capacity, participation to FIT and follow-up colonoscopy, screening intervals, time between FIT and colonoscopy, and detection rates of CRC and advanced neoplasia (AN)
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