Impact Of The Covid-19 Pandemic On Colorectal Cancer Screening Rates And Modalities In A Large Integrated Health System

INTRODUCTION: The novel coronavirus 2019 (COVID-19) pandemic has upended routine preventive care across the country. We sought to quantify the impact of the pandemic on colorectal cancer (CRC) screening rates and modalities utilized in a large academic health system. We hypothesized a drop in utilization of invasive screening modalities and a compensatory rise in non-invasive screening modalities. METHODS: We performed a retrospective analysis in a large academic health system. On 3/18/2020, all non-urgent elective endoscopic procedures were halted following recommendations from the United States Surgeon General. We utilized electronic health record (EHR) data to identify all patients who completed a screening endoscopy (colonoscopy or flexible sigmoidoscopy), fecal immunochemical test (FIT), computed tomography (CT) colonography, or stool DNA test during the cessation period (3/18/2020–5/4/2020) and during an equal time interval before the cessation (1/29/2020–3/17/2020). Our primary outcome was the total number of screening tests per day among primary care enrollees. Secondary outcomes included utilization of each screening modality. We used Student’s t-tests to compare utilization rates before and after endoscopy cessation overall and for each modality. RESULTS: In the period before COVID-19, the average screening rate was 64.1 ± 19.3 (Figure 1A), with colonoscopies (33.3 per day) and FIT (30.8 per day) comprising the majority of tests (Figure 1B). During the cessation period, the average daily screening rate declined to 12.1 ± 13.0 (Figure 2; P < 0.01). Colonoscopy saw the steepest decline (33.3 ± 11.2 to 0.2 ± 0.4 per day; P < 0.01). FIT use also declined significantly (30.8 ± 10.7 to 11.8 ± 12.9 per day; P < 0.01) but did begin to recover in later weeks of the cessation period (Figure 2). Colonoscopy and FIT made up 1.9% and 97.4% of tests, respectively, during the cessation period. Use of flexible sigmoidoscopy, CT colonography, and stool DNA was sparse throughout the study period. CONCLUSION: Utilization of CRC screening declined drastically in the wake of the COVID-19 pandemic, largely driven by a drop in invasive screening modalities. We observed a concomitant increase in non-invasive screening modalities though not sufficient to compensate for the overall drop in screening. This work highlights the impact of COVID-19 on preventive care and the need to promote non-invasive screening modalities until endoscopic capacity recovers.Figure 1.: (A) Average daily utilization for each CRC screening modality before and during cessation of non-urgent endoscopies; (B) Frequency of each CRC screening modality before and during cessation of non-urgent endoscopies.Figure 2.: CRC screening test utilization over time.