The Dartmouth Cancer Center, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America.
Prev Med. 2023 Oct;175:107649. doi: 10.1016/j.ypmed.2023.107649. Epub 2023 Jul 28.
The early COVID-19 pandemic was associated with cessation of screening services, but the prevalence of ongoing delays in cancer screening into the third year of the pandemic are not well-characterized. In February/March 2022, a population-based survey assessed cancer needs in New Hampshire and Vermont. The associations between cancer screening delays (breast, cervical, colorectal or lung cancer) and social determinants of health, health care access, and cancer attitudes and beliefs were tested. Distributions and Rao-Scott chi-square tests were used for hypothesis testing and weighted to represent state populations. Of 1717 participants, 55% resided in rural areas, 96% identified as White race, 50% were women, 36% had high school or less education. Screening delays were reported for breast cancer (28%), cervical cancer (30%), colorectal cancer (24%), and lung cancer (30%). Delays were associated with having higher educational attainment (lung), urban living (colorectal), and having Medicaid insurance (breast, cervical). Low confidence in ability to obtain information about cancer was associated with screening delays across screening types. The most common reason for delay was the perception that the screening test was not urgent (31% breast, 30% cervical, 28% colorectal). Cost was the most common reason for delayed lung cancer screening (36%). COVID-19 was indicated as a delay reason in 15-29% of respondents; 12-20% reported health system capacity during the pandemic as a reason for delay, depending on screening type. Interventions that address sub-populations and reasons for screening delays are needed to mitigate the impact of the COVID-19 pandemic on cancer burden and mortality.
新冠大流行早期与筛查服务的停止有关，但大流行第三年癌症筛查持续延迟的流行率尚不清楚。2022 年 2 月/3 月，一项基于人群的调查评估了新罕布什尔州和佛蒙特州的癌症需求。测试了癌症筛查延迟（乳腺癌、宫颈癌、结直肠癌或肺癌）与健康的社会决定因素、医疗保健可及性以及癌症态度和信念之间的关联。使用分布和 Rao-Scott 卡方检验进行假设检验，并进行加权以代表州人口。在 1717 名参与者中，55%居住在农村地区，96%为白人，50%为女性，36%受教育程度为高中或以下。报告了乳腺癌（28%）、宫颈癌（30%）、结直肠癌（24%）和肺癌（30%）的筛查延迟。延迟与较高的教育程度（肺癌）、城市居住（结直肠癌）和拥有医疗补助保险（乳腺癌、宫颈癌）有关。对获取癌症信息能力的低信心与所有筛查类型的筛查延迟有关。延迟的最常见原因是认为筛查测试不紧急（31%乳腺癌、30%宫颈癌、28%结直肠癌）。费用是肺癌筛查延迟的最常见原因（36%）。15-29%的受访者表示 COVID-19 是延迟的原因；12-20%的受访者报告大流行期间医疗系统能力是延迟的原因，具体取决于筛查类型。需要针对亚人群和筛查延迟的原因采取干预措施，以减轻 COVID-19 大流行对癌症负担和死亡率的影响。
