Colorectal cancer diagnoses dropped by 40% during pandemic
Amid lockdowns, many countries implemented a suspension of routine surveillance for colorectal cancer, resulting in fewer diagnoses in older patients with more complications, according to a presentation during UEG Week Virtual.
“We conclude that compared to the pre-pandemic period, the COVID pandemic was associated with a 40.4% decrease in the number of colorectal cancers diagnosed in a year’s time,” Maria J. Domper Arnal, of the Lozano Blesa University Hospital in Spain, said during a press conference. “Patients diagnosed of colorectal cancer during the pandemic period were older, had more frequent symptoms, an increased number of complications and a 20% more advanced stage of the disease.”
After the government implemented lockdown in Spain on March 14, 2020, Domper Arnal and colleagues analyzed the pre-pandemic period (March 1, 2019-March 14, 2020) as compared with the pandemic period (March 15, 2020-Feb. 28, 2021).
In the pre-pandemic period, hospitals in Spain performed 24,860 colonoscopies and diagnosed 868 cancers; during the COVID pandemic period of study, hospitals performed 17,337 colonoscopies and diagnosed 517 cancers. Of the expected incidence of CRC, this was a 40.4% decrease in diagnoses.
“There are significantly fewer tumors that were identified by colorectal cancer screening program during the pandemic period and more due to symptoms,” Domper Arnal said.
Patients presenting with serious complication at diagnosis also demonstrated this difference. Pre-pandemic, 10.6% of patients presented with serious complications while, during the pandemic, 14.7% presented with complications (P = .027). Perforation and abscess were more common pre-pandemic, but obstruction and bleeding requiring hospital admission were more frequent during the pandemic.
Additionally, patients diagnosed during the pandemic tended to be older by 2 years, with pre-pandemic patients having a median age of 72 years and those during the pandemic a median age of 74 years (P = .023).
Before the pandemic, 69% of patients had symptoms indicating the need for a colonoscopy. In contrast, 81.2% of patients during the pandemic had symptoms that required the colonoscopy (P < .001).
Domper Arnal also showed that screening using fecal immunochemical testing (FIT) was not as commonly used during the pandemic. Pre-pandemic, 21% had a positive FIT test as the indicator for colonoscopy, whereas during the pandemic just 4.3% had a positive FIT test (P < .001).
There was not a statistical difference between CRC stage at diagnosis between the two periods, but “there is a clear trend toward a higher presentation of stage 4 tumors in the pandemic period,” Domper Arnal said.
Diagnostic delay, though, was less during the pandemic, she said. Pre-pandemic, the time from colonoscopy request to date of performance was a median of 27 days, whereas during the pandemic, it was a median of 19 days (P = .013).
“This study reflects, at least in part, the short-term consequences of the suspension of colorectal cancer screening program in our area,” Domper Arnal said.