Markey Cancer Center, University of Kentucky, Lexington.
Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington.
JAMA Netw Open. 2024 Sep 3;7(9):e2432288. doi: 10.1001/jamanetworkopen.2024.32288.
US cancer diagnoses were substantially lower than expected during the COVID-19 pandemic in 2020. A national study on the extent to which rates recovered in 2021 has not yet been conducted.
To examine observed vs expected cancer rate trends for January 2020 to December 2021.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, population-based study of cancer incidence trends used the Surveillance, Epidemiology, and End Results 22 (SEER-22) Registries Database, which covers 47.9% of the US population. Included individuals were those with an invasive cancer diagnosis reported to registries included in SEER-22 between January 1, 2000, and December 31, 2021.
Age, sex, race and ethnicity, urbanicity, and stage at diagnosis.
Expected cancer incidence rates were measured for the COVID-19 pandemic years of 2020 and 2021 from prepandemic trends using ensemble forecasting methods. Relative difference between observed and expected cancer incidence rates and numbers of potentially missed cases were measured.
The SEER-22 registries reported 1 578 697 cancer cases in 2020 and 2021, including 798 765 among male individuals (50.6%) and 909 654 among persons aged 65 years or older (57.6%). Observed all-sites cancer incidence rates were lower than expected by 9.4% in 2020 (95% prediction interval [PI], 8.5%-10.5%), lower than expected by 2.7% in 2021 (95% PI, 1.4%-3.9%), and lower than expected by 6.0% across both years combined (95% PI, 5.1%-7.1%), resulting in 149 577 potentially undiagnosed cancer cases (95% PI, 126 059-176 970). Of the 4 screening-detected cancers, only female breast cancer showed significant recovery in 2021, exceeding expected rates by 2.5% (95% PI, 0.1%-4.8%), while significant reductions remained for lung cancer (9.1% lower than expected; 95% PI, 6.4%-13.2%) and cervical cancer (4.5% lower than expected; 95% PI, 0.4%-8.0%), particularly for early stage at diagnosis. Rates of all-sites cancer incidence returned to prepandemic trends in 2021 among female individuals, persons aged younger than 65 years, and persons of non-Hispanic Asian and Pacific Islander race and ethnicity.
This population-based cross-sectional study of US cancer incidence trends found that rates of diagnosis improved in 2021 but continued to be lower than expected, adding to the existing deficit of diagnosed cases from 2020. Particular attention should be directed at strategies to immediately increase cancer screenings to make up lost ground.
2020 年 COVID-19 大流行期间，美国的癌症诊断数量明显低于预期。尚未进行过关于 2021 年这些比率恢复程度的全国性研究。
检查 2020 年 1 月至 2021 年 12 月期间观察到的癌症发病率趋势与预期趋势之间的差异。
设计、地点和参与者：本项使用了涵盖美国 47.9%人口的监测、流行病学和最终结果 22 区（SEER-22）登记数据库的癌症发病率趋势的横断面、基于人群的研究。纳入的个体是在 2000 年 1 月 1 日至 2021 年 12 月 31 日期间，向 SEER-22 中包含的登记处报告有侵袭性癌症诊断的人。
年龄、性别、种族和民族、城市人口密度以及诊断时的分期。
使用综合预测方法，根据大流行前的趋势，对 2020 年和 2021 年 COVID-19 大流行年份的癌症发病率进行预测。测量观察到的和预期的癌症发病率之间的差异以及潜在漏诊病例的数量。
SEER-22 登记处报告了 2020 年和 2021 年的 1578697 例癌症病例，包括 798765 例男性病例（50.6%）和 909654 例 65 岁及以上人群病例（57.6%）。2020 年观察到的所有部位癌症发病率比预期低 9.4%（95%预测区间[PI]，8.5%-10.5%），2021 年比预期低 2.7%（95%PI，1.4%-3.9%），两年合计比预期低 6.0%（95%PI，5.1%-7.1%），导致 149577 例潜在未诊断的癌症病例（95%PI，126059-176970）。在 4 例筛查发现的癌症中，只有女性乳腺癌在 2021 年出现显著恢复，比预期高出 2.5%（95%PI，0.1%-4.8%），而肺癌（比预期低 9.1%；95%PI，6.4%-13.2%）和宫颈癌（比预期低 4.5%；95%PI，0.4%-8.0%）的显著下降仍在继续，尤其是在早期诊断阶段。在 2021 年，女性个体、65 岁以下个体以及非西班牙裔亚裔和太平洋岛民种族和民族的人群中，所有部位癌症发病率恢复到大流行前的趋势。
本项基于人群的美国癌症发病率趋势的横断面研究发现，诊断率在 2021 年有所改善，但仍低于预期，这加剧了 2020 年已诊断病例的不足。应特别关注立即增加癌症筛查的策略，以弥补损失。
