Notable Declines Observed in Diagnosis of Common Solid Malignancies During the First Year of the COVID-19 Pandemic

New diagnoses of common cancer types declined significantly during the first year of the COVID-19 pandemic.

A significant decline in new diagnoses of common malignancies such as prostate, breast, colorectal, lung, pancreatic, cervical, gastric, and esophageal cancers were noted during the first year of the COVID-19 pandemic, according to findings that were published in JAMA Network Open.1

Investigators identified significant declines across all cancer types, including a 21.2% decline in pancreatic cancer diagnoses (from 1177 to 927; P = .03) and 36.1% for breast cancer (from 9583 to 6122; P = .01). In the second pandemic period, the mean number of patients who were newly diagnosed with cancer per month was 29,304 for all 8 cancer types, revealing a 9.6% total decrease compared with pre-pandemic data. Within the third pandemic period, a 19.1% decrease in monthly diagnoses were noted, remaining significantly lower vs the pre-pandemic period across all cancer types included in the study. However, investigators noted that the magnitude of declines in diagnoses were lower in the first pandemic period.

“The significant decline in cancer diagnoses revealed by our Health Trends analysis raises the concern that more Americans are living with undiagnosed cancers because of the pandemic,” Yuri Fesko, MD, medical director of Quest Diagnostics Oncology, said in a press release.2 “In the past years, we’ve made so many therapeutic advances in cancer care, but if a cancer is not diagnosed, we can’t treat it. That’s why it’s important that patients engage in regular preventive care, including cancer tests and screenings, so that they have the best outcomes possible.”

The study analyzed de-identified laboratory data from Quest Diagnostics that included 799,486 patients who had been diagnosed with cancer during 4 time periods that were defined as pre-pandemic (January 2019-February 2020), pandemic period 1 (March 2020-May 2020), pandemic period 2 (June 2020 to October 2020), and pandemic period 3 (November 2020 to March 2021). The new analysis which expanded on a pervious published paper in August 2020 that identified a 46.4% decline in newly diagnoses cancers from March 1, 2020, to April 18, 2020, included 2 additional tumor types and highlighted a doublet digit decrease in diagnosis.3

In total, 45% of the study’s population were women and the mean age was 67.9 years. Additionally, 453,712 patients were included in the pre-pandemic period, 68,246 were included in pandemic period 1, 146,518 were in period 2, and 131,020 were in period 3.

The mean number of patients who were newly diagnosed with cancer were highest among those diagnosed with prostate cancer (n = 13,214), breast (n = 9583), CRC (n = 4101), lung (n = 3015), and pancreatic cancer (n = 1177); and lower among cervical (n = 493), gastric (n = 415), and esophageal cancer (n = 409).

Findings from the research indicate that patients may not have been able to undergo preventative or diagnostic care, such as routine screenings, that may have resulted in a diagnosis during the first year of the pandemic despite numerous restrictions being lifted in summer of 2020.

“Early screening, diagnosis, and treatment for cancer is critical to achieving the most favorable outcomes. Due to gaps in care throughout the pandemic, we can expect a future wave of patients presenting with cancer at more advanced stages of disease,” Harvey W. Kaufman, MD, senior medical director, head of the Health Trends Research Program at Quest Diagnostics, said in a press release. “Many of these patients, unfortunately, can expect more aggressive therapy and care with less favorable outcomes. We hope our study highlights the critical need for Americans to get back to their doctors and seek preventive and other forms of medical care without delay, so that potential cancers and other medical concerns are detected and treated early, when the best outcomes are possible.”

Notably, one limitation of the study is a lack of demographic data such as race and ethnicity or access to care. However, a survey that was given in November 2020 indicated that 49% of White Americans were more likely to have visited a doctor to receive any form of preventative care during the pandemic vs 32% of Hispanic and Latinx and 33% of Black Americans.4

References

  1. Kaufman HW, Chen Z, Niles JK, et al. Changes in newly identified cancer among US patients from before COVID-19 through the first full year of the pandemic. JAMA Netw Open. 2021;4(8):e2125681. doi:10.1001/jamanetworkopen.2021.25681
  2. Cancer diagnoses declined sharply during first year of COVID-19 pandemic, finds Quest Diagnostics Health Trends® study published in JAMA Network Open. News release. Quest Diagnosis. August 31, 2021. Accessed September 1, 2021. https://bit.ly/3gRpTQG
  3. Kauffman HW, Chen Z, Niles J, et al. Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw Open. 2020;3(8):e2017267. doi:10.1001/jamanetworkopen.2020.17267
  4. Quest Diagnostics Health Trends™ COVID-19: magnifying racial disparities in U.S. healthcare. News release. Quest Diagnostics. January 2021. Accessed September 1, 2021. https://bit.ly/3BnxtdU