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- Title
COVID-19 and Rates of Cancer Diagnosis in the US.
- Authors
Burus, Todd; Lei, Feitong; Huang, Bin; Christian, W. Jay; Hull, Pamela C.; Ellis, Amanda R.; Slavova, Svetla; Tucker, Thomas C.; Lang Kuhs, Krystle A.
- Abstract
Key Points: Question: To what extent did disruptions to the diagnosis of cancer in 2020 resolve during the second year of the COVID-19 pandemic in the US? Findings: This population-based cross-sectional study found that rates of observed cancer diagnoses improved in 2021 but still remained a significant 2.7% lower than expected. Among screening-detected cancers, female breast cancer showed significant rate recovery in 2021, colorectal cancer returned to prepandemic trends, and significant reductions in diagnoses remained for lung and cervical cancers. Meaning: This study suggests that cancer cases in the US continued to be underdiagnosed during the second year of the COVID-19 pandemic. Importance: US cancer diagnoses were substantially lower than expected during the COVID-19 pandemic in 2020. A national study on the extent to which rates recovered in 2021 has not yet been conducted. Objective: To examine observed vs expected cancer rate trends for January 2020 to December 2021. Design, Setting, and Participants: This cross-sectional, population-based study of cancer incidence trends used the Surveillance, Epidemiology, and End Results 22 (SEER-22) Registries Database, which covers 47.9% of the US population. Included individuals were those with an invasive cancer diagnosis reported to registries included in SEER-22 between January 1, 2000, and December 31, 2021. Exposures: Age, sex, race and ethnicity, urbanicity, and stage at diagnosis. Main Outcomes and Measures: Expected cancer incidence rates were measured for the COVID-19 pandemic years of 2020 and 2021 from prepandemic trends using ensemble forecasting methods. Relative difference between observed and expected cancer incidence rates and numbers of potentially missed cases were measured. Results: The SEER-22 registries reported 1 578 697 cancer cases in 2020 and 2021, including 798 765 among male individuals (50.6%) and 909 654 among persons aged 65 years or older (57.6%). Observed all-sites cancer incidence rates were lower than expected by 9.4% in 2020 (95% prediction interval [PI], 8.5%-10.5%), lower than expected by 2.7% in 2021 (95% PI, 1.4%-3.9%), and lower than expected by 6.0% across both years combined (95% PI, 5.1%-7.1%), resulting in 149 577 potentially undiagnosed cancer cases (95% PI, 126 059-176 970). Of the 4 screening-detected cancers, only female breast cancer showed significant recovery in 2021, exceeding expected rates by 2.5% (95% PI, 0.1%-4.8%), while significant reductions remained for lung cancer (9.1% lower than expected; 95% PI, 6.4%-13.2%) and cervical cancer (4.5% lower than expected; 95% PI, 0.4%-8.0%), particularly for early stage at diagnosis. Rates of all-sites cancer incidence returned to prepandemic trends in 2021 among female individuals, persons aged younger than 65 years, and persons of non-Hispanic Asian and Pacific Islander race and ethnicity. Conclusions and Relevance: This population-based cross-sectional study of US cancer incidence trends found that rates of diagnosis improved in 2021 but continued to be lower than expected, adding to the existing deficit of diagnosed cases from 2020. Particular attention should be directed at strategies to immediately increase cancer screenings to make up lost ground. This cross-sectional study examines trends in expected vs observed rates of cancer diagnoses in the US during the first 2 years of the COVID-19 pandemic.
- Subjects
UNITED States; TUMOR diagnosis; CROSS-sectional method; PUBLIC health surveillance; SURVIVAL; CERVIX uteri tumors; RESEARCH funding; EARLY detection of cancer; BREAST tumors; MEDICAL care; REPORTING of diseases; COVID-19 vaccines; CANCER patients; DESCRIPTIVE statistics; RACE; LUNG tumors; TUMORS; TUMOR classification; QUALITY assurance; COMPARATIVE studies; DATA analysis software; COVID-19 pandemic; DISEASE incidence; OVERALL survival
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2432288
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.32288