Clinical and translational gastroenterology · 2026
The Lingering Impact of the COVID-19 Pandemic on Colorectal Cancer Screening Modalities and Staging by Neighborhood-Level Deprivation.
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Romeiser Jamie L, Paterson Kristin, Allis Nicholas, Valentino Joseph, Stewart Telisa
Аннотация
INTRODUCTION: Disruptions to colorectal cancer (CRC) screenings occurred during the COVID-19 pandemic, but lingering effects and equity of this impact remain unclear. We evaluated local patterns and trends in CRC screening and cancer staging across 4 time periods and examined disparities by neighborhood social deprivation index (SDI).
METHODS: Colonoscopies, fecal immunochemical test (FIT), fecal occult blood test, and sigmoidoscopies were identified at our institution through electronic medical records from March 2018 to February 2023 (n = 27,946). Screenings were linked to zip code-level SDI and aggregated by month across 4 periods: prepandemic (March 2018-February 2020), pandemic (March 2020-February 2021), postpandemic year 1 (March 2021-February 2022), and postpandemic year 2 (March 2022-February 2023). Analysis of variances compared monthly screening volumes and proportions from high-SDI areas across periods; χ 2 tests assessed differences in cancer staging.
RESULTS: CRC screenings dropped during March-May 2020 but rebounded, resulting in no significant difference in monthly averages across periods ( P = 0.52). However, colonoscopies declined, whereas FIT use increased over time. The proportion of patients from high-SDI neighborhoods declined from 32.2% prepandemic to 28.9% by postpandemic year 2 ( P = 0.002), largely driven by reduced FIT screenings among individuals from these areas (30.9%-23.7%, P < 0.0001). Later-stage diagnoses increased during the pandemic and postpandemic year 1 but returned to baseline by year 2.
DISCUSSION: Despite volume recovery, shifts in modality use and declining representation from high-SDI neighborhoods suggest growing disparities in CRC screening. Targeted outreach is needed to understand and address unmet screening needs, to support equitable prevention efforts moving forward.
METHODS: Colonoscopies, fecal immunochemical test (FIT), fecal occult blood test, and sigmoidoscopies were identified at our institution through electronic medical records from March 2018 to February 2023 (n = 27,946). Screenings were linked to zip code-level SDI and aggregated by month across 4 periods: prepandemic (March 2018-February 2020), pandemic (March 2020-February 2021), postpandemic year 1 (March 2021-February 2022), and postpandemic year 2 (March 2022-February 2023). Analysis of variances compared monthly screening volumes and proportions from high-SDI areas across periods; χ 2 tests assessed differences in cancer staging.
RESULTS: CRC screenings dropped during March-May 2020 but rebounded, resulting in no significant difference in monthly averages across periods ( P = 0.52). However, colonoscopies declined, whereas FIT use increased over time. The proportion of patients from high-SDI neighborhoods declined from 32.2% prepandemic to 28.9% by postpandemic year 2 ( P = 0.002), largely driven by reduced FIT screenings among individuals from these areas (30.9%-23.7%, P < 0.0001). Later-stage diagnoses increased during the pandemic and postpandemic year 1 but returned to baseline by year 2.
DISCUSSION: Despite volume recovery, shifts in modality use and declining representation from high-SDI neighborhoods suggest growing disparities in CRC screening. Targeted outreach is needed to understand and address unmet screening needs, to support equitable prevention efforts moving forward.