Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study

• Published in: Preventive medicine Vol. 151; p. 106586
• Main Authors: Walker, Meghan J., Meggetto, Olivia, Gao, Julia, Espino-Hernández, Gabriela, Jembere, Nathaniel, Bravo, Caroline A., Rey, Michelle, Aslam, Usman, Sheppard, Amanda J., Lofters, Aisha K., Tammemägi, Martin C., Tinmouth, Jill, Kupets, Rachel, Chiarelli, Anna M., Rabeneck, Linda
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2021
• Subjects: Aftercare; Cancer screening; COVID-19; Delayed Diagnosis; Diagnostic assessment; Disparity; Early Detection of Cancer; Female; Humans; Lung Neoplasms; Ontario; Pandemics; SARS-CoV-2; Uterine Cervical Neoplasms; Ontario; CCC; ICMS; Lung-RADS; OR; MRI; OHIP; CI; LDCT; gFOBT; Cancer screening; COVID-19; FIT; Diagnostic assessment; OBSP; OCSP; RPDB; Disparity; OLSP
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2021.106586

It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019–December 31, 2020. Ontario's screening programs delivered 951,000 (−41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50–59 and 60–69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care. •Cancer screening test volumes in Ontario were reduced by 41% in 2020 compared to 2019.•A smaller percentage of cervical screening participants were from older age groups during the pandemic compared to 2019.•Older age was associated with diagnostic delay during the pandemic for all programs.•Lower income and high likelihood of living on a First Nation reserve were also associated with pandemic diagnostic delay.