Pandemic may have led to later presentation of colorectal, breast cancers
A single-center study in California found that more patients presented with stage I disease and fewer presented with stage IV disease in 2019 versus 2020, but the changes were statistically significant only for breast cancer.
Late-stage presentation of colorectal and breast cancers increased during the COVID-19 pandemic in 2020, corresponding with a decrease in the early-stage presentation of these cancers, a single-center study found.
Because the COVID-19 pandemic disrupted regular colonoscopies and mammograms, researchers assessed early- and late-stage colorectal and breast cancer diagnoses before and then during the pandemic. They reviewed cancer staging for patients at their first presentation at a cancer center at the University of California, San Diego, in 2019 and 2020. Results were published as a research letter by JAMA Network Open on Feb. 15.
Fifty-five men and 467 women were included in the study, and the mean age was 58.1 years. The total number of new patient visits for malignant neoplasm was similar in 2019 and 2020 (1,894 vs. 1,915), as was overall stage distribution for all patients with cancer: 605 patients (31.9%) with stage I disease in 2019 versus 556 (29.0%) in 2020 (odds ratio [OR], 1.15 [95% CI, 1.00 to 1.32]; P=0.05) and 492 patients (26.0%) with stage IV disease in 2019 versus 506 (26.4%) in 2020 (OR, 0.98 [95% CI, 0.84 to 1.13]; P=0.77).
After the start of the COVID-19 pandemic, the researchers noted a nonstatistically significant change in the number of patients presenting with stage I colorectal cancer in 2019 versus 2020 (8 [17.8%] vs. 6 [14.6%], respectively; OR, 1.26 [95% CI, 0.34 to 4.88]; P=0.78), as well as those presenting with stage IV disease (3 [6.7%] vs. 8 [19.5%], respectively; OR, 0.30 [95% CI, 0.05 to 1.37]; P=0.11). For breast cancer, a significantly higher percentage of patients presented with stage I disease in 2019 versus 2020 after the pandemic (138 [63.9%] vs. 116 [51.3%], respectively; OR, 1.67 [95% CI, 1.13 to 2.47]; P=0.008), while significantly fewer presented with stage IV breast cancer (4 [1.9%] vs. 14 [6.2%], respectively; OR, 0.33 [95% CI, 0.09 to 0.98]; P=0.04).
The researchers noted that their study included patients seeking a second opinion and that the numbers of patients with colorectal cancer were relatively small. “There is increasing concern regarding the effect of the COVID-19 pandemic on cancer mortality, as the evidence suggests that the number of patients presenting at late, incurable stages is increasing,” the researchers wrote. “Patients who have delayed preventative care during the pandemic should be encouraged to resume treatment as soon as possible.”