Screening for breast, colorectal cancer rebounded after COVID-19

Rates of reported breast and colorectal cancer screening rebounded in 2023 from declines related to the COVID-19 pandemic, a recent study found.

Researchers used data from the National Health Interview Survey to estimate changes in cancer screening before (2019), during (2021), and after (2023) the COVID-19 pandemic. U.S. Preventive Services Task Force recommendations that were in effect in 2019 were used to define screening eligibility and methods. The study's primary outcomes were self-reported breast, cervical, and colorectal cancer screening, with colonoscopy and stool-based testing both also measured separately. The results were published as a research letter by JAMA on March 5.

In the 2023 survey, 6,829 individuals were eligible for breast cancer screening, 8,888 for cervical cancer screening, and 13,144 for colorectal cancer screening. Reported screening in the past year between 2019 and 2023 increased by 7% for breast cancer (prevalence estimate, 59.7% to 64.9%; adjusted prevalence ratio [aPR], 1.07 [95% CI, 1.04 to 1.10]) and 12% for colorectal cancer (prevalence estimate, 21.2% to 24.3%; aPR, 1.12 [95% CI, 1.06 to 1.18]). Between 2021 and 2023, there were rebounds in breast cancer screening (56.9% to 64.9%; aPR, 1.14 [95% CI, 1.11 to 1.18]) and colonoscopy screening (13.8% to 15.7%; aPR, 1.13 [95% CI, 1.06 to 1.22]), and a sustained increase was seen in stool testing (6.6% in 2019 vs. 10.1% in 2021 and 2023). Reported cervical cancer screening, however, remained 14% below 2019 estimates in 2023 (prevalence estimate, 46.8% to 40.9%; aPR, 0.86 [95% CI, 0.82 to 0.90]) and had not changed since 2021.

Limitations of the study included decreases in responses to the National Health Interview Survey over time and potential effects of social desirability and recall biases, the authors noted.

“In 2023, reported breast and colorectal cancer screening rebounded from COVID-19 pandemic-related declines and surpassed prepandemic estimates. These findings are encouraging given larger-than-expected declines in early-stage breast and colorectal cancer diagnoses in 2020 and increases in distant-stage breast cancer diagnoses through 2021,” they wrote. They called the persistent low rate of cervical cancer screening “a troubling trend as early-stage diagnoses continued to decrease in 2021.” Patients may lack knowledge about cervical cancer screening, and physicians may not consistently recommend it, they noted.

Another study related to preventive care was published by Annals of Internal Medicine on March 11. A systematic review of 74 studies on preventive services for patients with disabilities found that while barriers to such services often occur at the environmental, individual, clinician, and health care levels, randomized studies on interventions tend to target only patients, caregivers, and clinicians. The researchers called for future studies on interventions to examine various types and combinations of barriers and facilitators and different preventive services and disability types, stressing that including the experiences of people with disabilities in this work is vitally important.

The authors of an accompanying editorial pointed out there are opportunities to address underlying factors affecting health disparities for people with disabilities at all levels of care, noting that they “concur with the authors' call for a ‘broad conception of accessibility’ in preventive care and support continued efforts to address the barriers to and facilitators of preventive care for [people with disabilities].”