Deadly Delays in CRC Screening During COVID-19 Pandemic

Delays in colorectal cancer screenings during this year’s coronavirus pandemic will result in a 12% increase in cancer deaths over the next five years, Italian researchers have found.

During the pandemic, many people have delayed elective health screenings, mostly due to halting of screening programs. Although colorectal cancer is highly treatable if caught early, it is more difficult to manage the later it is detected.

“In the wake of possible new pandemics or surges of COVID-19, we need to have an unbroken prevention path for high-impact diseases,” Luigi Ricciardiello, MD, an associate professor at the University of Bologna, in Italy, and lead author of the study, said. Dr. Ricciardiello’s group, which included researchers at the University of Parma, Humanitas University, the University of Bergamo and the IRCCS Fatebenefratelli in Brescia, presented their findings at the 2020 virtual United European Gastroenterology Week (abstract P1470).

Before the pandemic, Italian health authorities sent 500,000 notices per month to patients encouraging colorectal cancer screenings, a concerted approach that Dr. Ricciardiello dates to 2004 and 2005. This effort has generated a trove of data about how quickly people were screened after receiving this notice, as well as of how many detected cancers were at early, easier-to-treat stages (stage I or II). Ricciardiello and his colleagues used these data to predict the long-term impact of screening delays linked to the pandemic.

According to their model, at seven to 12 months of screening delays, 29% of detected colorectal cancers will be advanced (stages III-IV). Screening delays of more than a year will result in 33% of cancers being advanced. The longest delays equate to an increase in deaths of 11.9% in the next five years compared with catching advanced cancer earlier.

“The risk is to go backward,” Dr. Ricciardiello said. “In many regions screening has resumed; however, in many areas the situation is very complicated, especially in the South [of Italy]. We could face a situation like in the early 2000s, the prescreening era.”

“There are many health conditions that we are probably going to see higher rates of in the future, because they are not getting the attention that they warrant and need now,” Folasade May, MD, PhD, MPhil, the director of the Melvin and Bren Simon Gastroenterology Quality Improvement Program at UCLA Health, in Los Angeles, said. “We are probably going to see an uptick in the number of cancers over time, due to delays in health care and particularly delays in screening.”

Dr. May was not involved in the Italian research, but her own work at UCLA also found a drop in screening rates. In a presentation at the 2020 annual meeting of the American College of Gastroenterology, Dr. May and her colleagues reported that colonoscopies plummeted at the beginning of the pandemic and that fecal immunochemical tests (FITs) also declined dramatically (poster P0761).

Between Jan. 29 and March 17—just before UCLA Health ceased elective colonoscopies as the pandemic took hold—its physicians conducted an average of 33 colonoscopies or ordered 31 FITs per day. From March 18 to May 4, the number of colonoscopies plummeted to essentially zero per day (0.22). The number of FITs ordered scraped zero between March 18 and April 15, too, before beginning to rebound. By May 4, UCLA Health was averaging 12 FITs per day, while colonoscopies were still essentially nil.

While Dr. May said FIT is a viable screening tool for many patients, she also noted that endoscopy units are much safer for patients and providers alike than at the start of the pandemic. Patients must show proof of a recent negative COVID-19 test to undergo a colonoscopy, and providers are now outfitted with personal protective equipment from head to toe. Although delaying a colonoscopy in March or April this year made sense, patients now do not need to keep putting off the procedure.

This article is from the December 2020 print issue.