Association of health care policy and trends in cancer screening during the COVID-19 pandemic

Introduction

Cancer screening trends and associations with statewide containment policies during the COVID-19 pandemic are not fully understood. We sought to examine trends in screening rates for prostate, breast, cervical, colon, and lung cancer from March to December 2020, and to examine whether statewide containment policies were associated with screening rates.

Methods

We performed a retrospective cohort studying using the Healthjump dataset, which comprises encounter-level data for more than 40 million patients across the United States. Individuals with at least one cancer screening test between 1/2016 and 12/2020 were included. Expected screenings during the pandemic were calculated using a seasonally-adjusted model and compared with observed values. The association with containment policies was estimated by comparing these ratios to statewide stringency indices measured by the Oxford COVID-19 Government Response Tracker.

Results

There was a negative, significant association between statewide stringency policies and observed-to-expected screening ratios for all cancers. In addition, there was a rapid decrease in the observed-to-expected screening ratios for all cancers in April 2020 followed by a rise in screening for all cancers in the latter half of 2020. Prostate, cervical, colon, and lung cancer screening increased beyond expected counts, while breast cancer screening approached expected counts.

Conclusions

More stringent statewide containment policies were negatively associated with screening rates. These rates decreased during the early phase of the COVID-19 pandemic, but subsequently increased to normal or near-normal.