Self-reported delays show pandemic’s effect on cancer screening

Self-reported delays show pandemic’s effect on cancer screening

By Amerigo Allegretto, staff writer

August 1, 2023 — About one in four women and one in three patients are reporting delays in breast and lung cancer screening stemming from the COVID-19 pandemic, according to survey findings published July 28 in Preventive Medicine.

A team led by Christine Gunn, PhD, from the Dartmouth Cancer Center in Lebanon, NH, also found that low confidence in obtaining cancer information is tied to deferred exams across screening types and that perceiving screening tests as not urgent is the most common reason for delays.

“Concerted efforts to increase cancer screening are imperative to reduce the impact of COVID-19 on cancer burden in the U.S.,” Gunn and colleagues wrote.

It’s been more than two and a half years since the initial peak of the COVID-19 pandemic in the U.S., which caused imaging facilities to temporarily close as medical resources were reallocated toward fighting the disease. This meant cancer screenings had to be delayed, though screening numbers have since rebounded.

Still, the researchers noted that ongoing delays in cancer screening are still not understood. Gunn and co-authors wanted to better understand self-reported reasons from patients who continue to delay screening exams, noting that doing so could help identify opportunities for cancer center community outreach and educational interventions.

The team included 2022 survey data from 1,717 participants from New Hampshire and Vermont. Of these, 55% of respondents resided in rural areas, 96% identified as white, 50% were women, and 36% had an education level of high school or less.

The researchers found that 28% of breast cancer screening respondents (173 of 606) reported exam delays; 30% (156 of 527) of respondents reported cervical cancer screening exam delays; 24% (216 of 887) of respondents reported colorectal cancer screening exam delays; and 30% (21 of 70) of respondents reported lung cancer screening exam delays.

The team analyzed several social determinants of health domains and found the following:

  • About 69% of participants who reported a delay in lung cancer screening had a higher level of education.
  • About 58% of participants who reported deferred colorectal cancer screening lived in urban areas.
  • Having Medicaid insurance was tied to delay for breast cancer (20% with delay vs. 9% without delay) and for cervical cancer screening (15% with delay vs. 9% without delay).
  • Financial insecurity was tied to delays for colorectal cancer screening (61% with delay vs. 43% without delay).
  • Deferred exams were more common in the 50 to 64 age group for breast cancer (61% with delay, 35% without delay); and 45 to 75 years for colorectal cancer (87% with delay, 67% without delay).

The researchers also found that deferred exams were more likely among participants who stated that they were not very or not at all confident in their ability to get advice or information about cancer. More specifically, 9% of survey participants who reported a delay in breast cancer screening stated low confidence in obtaining such information or advice about cancer, while only 1% in this screening group without delay reported low confidence. This trend went for all cancers analyzed.

Finally, the team found that deeming cancer screening as not urgent was the most reported reason for delaying screening. This included 31% of the breast screening cohort, 30% of the cervical cohort, and 28% for the colorectal group. However, insurance or costs were the top reason for the lung cancer screening group, at 36%. Participants also cited COVID-19 illness or concerns as another reason for delays, which ranged from between 15% and 29% for all cancer groups.

The study authors suggested that based on their findings, cancer screening centers can implement interventions to change screening behaviors, such as risk-based screening and management strategies.

“Interventions may include educational outreach, protocols to prioritize high-risk individuals for reengagement in cancer screening and addressing patient COVID-19-related concerns, and expansion of home-based screening modalities,” the authors concluded.

The full study can be found here.