Study data published in Clinical Gastroenterology and Hepatology underline the potential consequences of delaying colorectal cancer (CRC) screening programs during the coronavirus disease 2019 (COVID-19) pandemic. In a procedural model that incorporated data from the general population, even minor delays in screening were associated with increased rates of advanced CRC and elevated risk for mortality.
Investigators built a procedural model to assess the consequences of delayed screening procedures during the COVID-19 pandemic. PubMed and Scopus databases were searched for studies reporting the distribution of CRC status among patients who received a colonoscopy after a positive fecal immunochemical test (FIT). Time to screening was classified as baseline (0-3 months), short (4-6 months), moderate (7-12 months), and long (>12 months). Mortality rates and CRC status distribution were calculated for each time-to-screening stratum. These estimates were applied to CRC data extracted from national patient registers in Italy.
With a delay of 0 to 3 months, 74% of CRC cases were expected to be stage I or stage II. This proportion increased to 76% with a delay of 4 to 6 months (P >.05). Compared to baseline (0-3 months), screening delayed by 7 to 12 months was associated with a significant increase in the detection of stage III and IV cancers (from 26% to 29%; P =.08). This trend progressively worsened with a 12-month delay (from 26% to 33%; P <.01). These projected increases in advanced CRC cases corresponded with poorer overall survival in the screening population. Mortality data from the pre-COVID-19 era were applied to the projected number of CRC cases in Italy. Compared to a 0- to 3-month delay, a greater than 12-month delay was associated with a 12% increase in the number of deaths due to CRC (P =.005).
The main study limitation was the small number of primary studies included in both meta-analyses.
These data demonstrate that advanced screening delays would increase CRC mortality by allowing progression to more advanced stages. “[In light] of possible future waves of SARS-CoV-2 or other pandemics, our findings warn against screening delays above 12 months to restrain the negative impact on disease mortality,” investigators concluded.
Ricciardiello L, Ferrari C, Cameletti M, et al. Impact of SARS-CoV-2 pandemic on colorectal cancer screening delay: effect on stage shift and increased mortality. Published online September 6, 2020. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.09.008