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TOPLINE:

Breast and colorectal cancer screening rates in 2023 surpassed pre-pandemic levels with increases of 7% and 12%, respectively, while cervical cancer screening remained 14% below 2019 levels. Improvements were primarily observed among individuals with higher education, private insurance, or Medicare insurance.

METHODOLOGY:

• The COVID-19 pandemic caused widespread disruptions in cancer screening that had not fully recovered by 2021. Early-stage cancer diagnoses decreased during that time, which contributed to an increase in the proportion of later-stage cancer diagnoses.
• Analysis included data from the National Health Interview Survey, a nationally representative cross-sectional household survey of noninstitutionalized adults in the United States.
• Researchers examined screening rates during three distinct periods: Before (2019), during (2021), and after (2023) the COVID-19 pandemic, with eligibility defined by US Preventive Services Task Force recommendations.
• A total of 6829 individuals were eligible for breast cancer screening, 8888 for cervical cancer screening, and 13,144 for colorectal cancer screening in 2023.
• Logistic regression models in SAS-callable SUDAAN version 9.4 estimated adjusted prevalence ratios (aPRs) comparing cancer screening between periods, with adjustments for age, race and ethnicity, education, insurance, and region.

TAKEAWAY:

• Breast cancer screening prevalence increased from 59.7% to 64.9% between 2019 and 2023 (aPR, 1.07; 95% CI, 1.04-1.10), with a significant rebound between 2021 and 2023 (aPR, 1.14; 95% CI, 1.11-1.18).
• Colorectal cancer screening showed a 12% increase from 21.2% to 24.3% (aPR, 1.12; 95% CI, 1.06-1.18), driven by both colonoscopy rebound and sustained increase in stool testing.
• Cervical cancer screening remained 14% below 2019 levels (46.8%-40.9%; aPR, 0.86; 95% CI, 0.82-0.90) and unchanged from 2021.
• College graduates showed a 17% increase in colorectal cancer screening between 2019 and 2023, while individuals with high school education or less showed no significant change.

IN PRACTICE:

"Breast cancer screening met or exceeded pre-pandemic levels across most education groups. However, other cancer screening improvements were mostly restricted to individuals with higher education, private insurance, or Medicare insurance, continuing previously documented pandemic-related trends. To prevent further shifts toward later-stage diagnoses, efforts must address declines in cervical cancer screening and disparities by socioeconomic status in all three screening types. Health systems and healthcare professionals could play a major role by improving screening communications and providing patient navigators to help address structural and cost barriers,” wrote the authors of the study.

SOURCE:

The study was led by Jessica Star, MA, MPH, Surveillance and Health Equity Science, American Cancer Society in Atlanta. It was published online on March 5 in JAMA.

LIMITATIONS:

The study was limited by decreasing response rates over time (59.1% in 2019, 50.9% in 2021, and 47.0% in 2023) and potential social desirability and recall biases. Additionally, the data did not distinguish between colonoscopies performed for screening, surveillance, or diagnosis after a positive past-year noncolonoscopy test result.

DISCLOSURES:

No relevant conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.