Screening delays due to SARS-CoV-2 could increase advanced CRC cases
Delays in colorectal cancer screening due to the cessation of colonoscopies during the COVID-19 pandemic could increase advanced cases and even mortality if the delay stretches beyond 1 year, according to study results.
Luigi Ricciardiello, MD, from the department of medical and surgical sciences at the University of Bologna in Italy, and colleagues wrote that screening programs have been limited since the start of the pandemic, and they wanted to determine what impact that might have on outcomes.
“Recent data highlighted the detrimental effects on mortality of delaying diagnosis in symptomatic patients with CRC in the United Kingdom, due to SARS-Cov-2 pandemic,” the investigators wrote. “However, screening delays might have even more dramatic effects than delayed diagnosis, once the downstaging effect is reversed by the delays.”
Researchers built a procedural model to consider delays in the time to colonoscopy and estimated the effect on mortality due to up-stage migration of patients. They computed the number of expected cases of CRC using data from the screened Italian population and used a meta-analytic approach to estimate the effect on cancer stage and mortality.
Compared with a baseline of 0 to 3 months, investigators found that moderate (7-12 months) and long (>12 months) delays in screening could lead to an increase in advanced CRC (from 26% [P = .008] to 29% and 33% [P < .001], respectively).
When the length of delay lasted longer than a year, researchers estimated that the total number of deaths could increase by 12% (P = .005), as well as a change in mortality distribution by stage when compared with baseline (P < .001).
“Our study shows that CRC screening delays beyond 6 months would result in a significantly higher number of more advanced CRC cases,” Ricciardiello and colleagues wrote. “We believe that alternative strategies should envision future lockdowns and social distancing, re-thinking the paths of distribution and analysis of the tests, and the possibility of managing screening-only, SARS-CoV-2-free, dedicated facilities.”