Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
Prev Med. 2021 Oct;151:106586. doi: 10.1016/j.ypmed.2021.106586.
It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019-December 31, 2020. Ontario's screening programs delivered 951,000 (-41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50-59 and 60-69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.
量化 COVID-19 大流行对癌症筛查的影响，包括脆弱亚人群的影响，对于制定基于证据的、有针对性的大流行恢复策略至关重要。我们在加拿大安大略省进行了一项基于人群的回顾性观察研究，以评估大流行对有组织的癌症筛查和诊断服务的影响，并评估在大流行期间，不同人群亚组的癌症筛查服务使用和诊断延迟模式是否存在差异。利用省级卫生数据库，确定了年龄符合条件的个体，这些个体在 2019 年 1 月 1 日至 2020 年 12 月 31 日期间参加了安大略省的一项或多项乳腺癌、宫颈癌、结直肠癌和肺癌筛查计划。安大略省的筛查计划在 2020 年提供的筛查测试比 2019 年少了 951,000 次（减少了 41%），到 2020 年底，大多数计划的数量仍比历史水平低 20%以上。与 2019 年相比，大流行期间参加宫颈癌筛查的参与者年龄更大（50-59 岁和 60-69 岁）。在大流行期间，年龄最大的人群和收入较低的社区的个体在接受异常的乳腺癌、宫颈癌或结直肠癌筛查测试后，经历诊断延迟的可能性显著更高，而有很大可能居住在第一民族保留地的个体在接受异常粪便检查后，经历诊断延迟的可能性显著更高。必须继续对积压进行持续监测和管理。需要进一步评估，以确定癌症筛查和诊断护理机会受到不成比例影响的人群，并量化这些服务中断对癌症发病率、分期和死亡率的影响。这些信息对于旨在实现公平和及时获得癌症筛查相关护理的大流行恢复工作至关重要。
