Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, Georgia.
Now with Department of Hematology and Oncology, Emory University, Atlanta, Georgia.
JAMA Netw Open. 2022 Jun 1;5(6):e2215490. doi: 10.1001/jamanetworkopen.2022.15490.
Health care was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased greatly, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported.
To examine changes in breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening prevalence with contemporary national, population-based Behavioral Risk Factor Surveillance System (BRFSS) data.
DESIGN, SETTING, AND PARTICIPANTS: This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women aged 50-74 years), CC (women aged 25-64 years), and CRC (women and men aged 50-75 years) screening. Data analysis was performed from September 2021 to February 2022.
Calendar year.
Self-reported receipt of a recent (defined as in the past year) BC, CC, and CRC screening test. Adjusted prevalence ratios (aPRs) comparing 2020 vs 2018 prevalence and 95% CIs were computed.
In total, 479 248 individuals were included in the analyses of BC screening, 301 453 individuals were included in CC screening, and 854 210 individuals were included in CRC screening, In 2020, among respondents aged 50 to 75 years, 14 815 (11.4%) were Black, 12 081 (12.6%) were Hispanic, 156 198 (67.3%) were White, and 79 234 (29.9%) graduated from college (all percentages are weighted). After 4 years (2014-2018) of nearly steady prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94; 95% CI, 0.92-0.96), and CC screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91). The magnitude of these decreases was greater in people with lower educational attainment and Hispanic persons. CRC screening prevalence remained steady; past-year stool testing increased by 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95% CI, 0.82-0.88) between 2018 and 2020.
In this survey study, stool testing increased and counterbalanced a decrease in colonoscopy during 2020, and BC and CC screening modestly decreased. How these findings might be associated with outcomes is not yet known, but they will be important to monitor, especially in populations with lower socioeconomic status, who experienced greater screening decreases during the COVID-19 pandemic.
2020 年 COVID-19 大流行期间，美国的医疗保健服务受到了干扰。早期在选定样本中的报告表明，癌症筛查服务大幅减少，但尚未报告 2020 年期间基于人群的癌症筛查流行率估计。
使用当代全国性、基于人群的行为风险因素监测系统 (BRFSS) 数据，研究乳腺癌 (BC)、宫颈癌 (CC) 和结直肠癌 (CRC) 筛查流行率的变化。
设计、地点和参与者：本调查研究包括 2014 年、2016 年、2018 年和 2020 年 BRFSS 调查中符合 BC（年龄在 50-74 岁的女性）、CC（年龄在 25-64 岁的女性）和 CRC（年龄在 50-75 岁的女性和男性）筛查条件的受访者。数据分析于 2021 年 9 月至 2022 年 2 月进行。
日历年度。
自我报告最近（定义为过去一年）接受 BC、CC 和 CRC 筛查测试。计算了 2020 年与 2018 年流行率以及 95%CI 比较的调整后患病率比 (aPR)。
在总计 479248 名接受 BC 筛查分析的受访者中、301453 名接受 CC 筛查的受访者中以及 854210 名接受 CRC 筛查的受访者中，在 50 至 75 岁的受访者中，14815 人（11.4%）为黑人，12081 人（12.6%）为西班牙裔，156198 人（67.3%）为白人，79234 人（29.9%）毕业于大学（所有百分比均为加权）。在经过四年（2014-2018 年）几乎稳定的流行率后，2018 年至 2020 年间，过去一年的 BC 筛查率下降了 6%（从 2018 年的 61.6%降至 2020 年的 57.8%；aPR，0.94；95%CI，0.92-0.96），CC 筛查率下降了 11%（从 2018 年的 58.3%降至 2020 年的 51.9%；aPR，0.89；95%CI，0.87-0.91）。这些下降的幅度在受教育程度较低和西班牙裔人群中更大。CRC 筛查率保持稳定；过去一年的粪便检测增加了 7%（aPR，1.07；95%CI，1.02-1.12），抵消了 2018 年至 2020 年间结肠镜检查减少 16%（aPR，0.84；95%CI，0.82-0.88）。
在这项调查研究中，粪便检测增加，抵消了结肠镜检查减少的影响，BC 和 CC 筛查略有下降。这些发现如何与结果相关尚不清楚，但在经历 COVID-19 大流行期间筛查率大幅下降的社会经济地位较低的人群中，这些发现将非常重要，需要进行监测。
