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).

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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.

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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