As Cancer Screenings Increase in Late 2020, Racial and Economic Disparities Persist for Some Tests

Racial and economic disparities continue for certain cancer tests, even as cancer screenings rebound from the COVID-19 pandemic, according to a press release from Dana-Farber Cancer Institute.¹

Investigators noted an increase in all tests performed during September 2020 to December 2020, compared with pre-pandemic times December 2019 to March 2020 with the exception of colonoscopy.² Some of the tests included Papanicolaou smear which increased by 2% and prostate-specific antigen (PSA) testing, which increased by 24%. There was also an increase in cancer positive diagnoses occurred across all categories except colonoscopy during the same time period, ranging from 1%-38%.

During September 2020 to December 2020, colonoscopy tests and associated diagnoses had a 15% and 30% decrease, respectively, compared with the December 2019 to March 2020 pre-pandemic period. Additionally, from March 2020 to June 2020 and June 2020 to September 2020, there was a decrease in cancer testing that ranged from 65% to 82% and 4% to 44% depending on the test.

“The increase in screening tests that was identified from September [2020] to December 2020 helped to recover some of the ‘missed’ cancer diagnoses from earlier time periods,” co-first author of the study Chris Labaki, MD, of Dana-Farber Cancer Institute, said in a press release. “However, more efforts are still needed to ensure the implementation of large screening campaigns, as a significant proportion of cancers remains undiagnosed.”

A decrease in mammographies was identified among Non-Hispanic Black and Hispanic patients from June 2020 to September 2020 and September 2020 to December 2020. Higher proportions of Non-Hispanic White patients were tested between June to September 2020 and September to December 2020 compared with 3 months before the pandemic (83.2% and 82.0%, respectively vs 79.0%; P = .001), as well as a lower proportions of Black patients (5.2% and 5.3% vs 6.3%, P< .001) and Hispanics/Latinas(2.4% and 2.6% vs 3.3%; P< .001).

“These findings are concerning and suggest the pandemic may accentuate racial disparities related to cancer screening,” the authors of the study wrote.

The beginning of the pandemic produced 1985 positive cases of cancer between the months of March 2020 to June 2020. From September 2020 to December 2020, there were 3476 positive cases of cancer reported, leaving potentially 1187 cases that were missed due to the pandemic.

The screening tests that were evaluated for potential disparities included mammography, PSA, colonoscopy, Papanicolaou test, and low-dose CT scan. From March 2020 to June 2020, 15,453 patients were screened for cancer, compared with 72,156 patients who were screened from September 2020 to December 2020, surpassing those who were tested during the pre-pandemic period (n = 64,269).

Although additional data from the study indicated that investigators identified socioeconomic and racial disparities among patients who received a mammography, those who received screenings for PSA, colonoscopy, Papanicolaou test, and CT had the same racial proportions. 

A better socioeconomic status was observed from June 2020 to December 2020 among patients undergoing mammography and colonoscopy compared with the pre-pandemic period; the changes were statistically significant compared with each of the 4 pre-pandemic periods included in the study.

Gender did not appear to play a role in screening procedures for colonoscopy or low-dose CT scan. Age had a standardized mean difference of 0.002 and 0.37 for all pairwise comparisons. 

“We don’t want to miss out on cancer screenings,” Toni K. Choueiri, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber, said in a press release. “We would want patients to come back to discuss with us and their primary care providers and to embark on screening following the national COVID-19 pandemic guidelines.”

References:

Cancer screenings rebounded in late 2020 after COVID-related decline, but racial and economic disparities remain for some tests. News Release. Dana-Farber Cancer Institute. July 7, 2021. Accessed July 8, 2021. https://bit.ly/2UuWxzp

Labaki C, Bakouny Z, Schmidt A, et al. Recovery of cancer screening tests and possible associated disparities after the first peak of the COVID-19 pandemic. Cancer Cel. Available online July 1, 2021. doi:10.1016/j.ccell.2021.06.019.