During the COVID-19 pandemic, guidelines from the American Society of Clinical Oncology and other organizations have recommended that cancer screening procedures involving in-person visits, such as mammograms and colonoscopies, be postponed. These delays have contributed to a whopping 46.4% drop in the combined rate of new diagnoses for six cancers.
This is the finding of a cross-sectional study, results of which have now been published in a research letter in JAMA Network Open, assessing data from patients across the United States who received testing for any cause by Quest Diagnostics and whose ordering physicians assigned them International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes associated with breast, colorectal, lung, pancreatic, gastric, or esophageal cancer. Each patient was counted once at the first instance of each cancer-related ICD-10 code in a weekly count tracked from the first full calendar week of January 2019 through April 18, 2020.
Of the 278,778 patients included in the study, 92.8% were diagnosed during the baseline period, and 7.2% were diagnosed during the pandemic. The study population was 75.1% female, with a mean age of 66.1 years. During the pandemic, the weekly incidence of new cancer-related ICD-10 codes fell 46.4% for all six cancers combined, from 4,310 to 2,310. The decline, which was seen across all cancer types, was least in pancreatic cancer, with a 24.7% reduction, and greatest in breast cancer, for which diagnoses fell by 51.8%.
The mean age of patients diagnosed with cancer during the pandemic was within one year of the baseline age, with patients diagnosed with esophageal cancer during this time being slightly older compared with their pre-pandemic counterparts (69.5 vs 68.4 years) while patients with all other cancers were slightly younger. Sex distribution of diagnoses did not change except for pancreatic cancer, for which a higher proportion of the diagnoses during the pandemic were in women (53.0% vs 49.8% during the baseline period).
"Our pre-pandemic data represented a good share of the National Cancer Institute weekly incidence estimates of the six cancers, ranging from 16% (lung cancer) to 42% (breast cancer)," note the investigators, led by first author Harvey W. Kaufman, MD, Senior Medical Director of Medical Informatics at Quest Diagnostics in Secaucus, New Jersey.
"While residents have taken to social distancing, cancer does not pause. The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes. One study suggests a potential increase of 33,890 excessive cancer deaths in the United States," comment Dr. Kaufman and colleagues. "Our findings are consistent with previous research, and they call for urgent planning to address the consequences of delayed diagnoses."
For More Information
Kaufman HW, Chen Z, Niles J, et al (2020). Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw Open, 3(8):e2017267. DOI:10.1001/jamanetworkopen.2020.17267
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