Englum Brian R, Sahoo Shalini, Mayorga-Carlin Minerva, Siddiqui Tariq, Turner Douglas J, Baquet Claudia R, Sorkin John D, Lal Brajesh K
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA.
Ann Surg Oncol. 2025 Jun;32(6):4228-4239. doi: 10.1245/s10434-025-17153-8. Epub 2025 Mar 20.
The coronavirus disease-2019 (COVID-19) pandemic caused disruptions in cancer screening and diagnosis, including colorectal cancer. Given disparities in cancer and COVID-19 faced by historically disadvantaged minorities, we examined changes in disparities in colorectal cancer screening and diagnosis in the COVID era.
In a cohort study using the Veterans' Affairs Health Care System (VAHCS) from 2018 through 2021, we quantified colonoscopies, fecal occult blood tests (FOBT), and new diagnoses of colorectal cancer (CRC) by month from 1 March 2018 to 31 December 2021. We compared the pre-COVID (before 1 March 2020) to the COVID (1 March 2020 and after) era. We graphed temporal trends by age, sex, race, ethnicity, rural-urban, and socioeconomic status (SES). Logistic regression was used to evaluate temporal trends after adjusting for confounders.
During the study period, there were about 900,000 colonoscopies, 1.4 million FOBTs, and > 30,000 new diagnoses of CRC. Colonoscopies and new CRC decreased dramatically during the early COVID era to < 10% and < 60% of pre-COVID rates, respectively. Although we identified a modest increase in disparities of colonoscopy use among Black and Latino patients in the early COVID era, these increased disparities did not persist in adjusted analysis. We did not identify changes in disparities in FOBT use or new CRC diagnoses.
We did not identify increased disparities in CRC screening or diagnoses by age, sex, race, ethnicity, geographic region, or SES in the VAHCS. These results indicate a potential strength of the VAHCS and require further study in additional cancers and healthcare systems.
2019年冠状病毒病（COVID-19）大流行导致癌症筛查和诊断受到干扰，包括结直肠癌。鉴于历史上处于弱势的少数群体在癌症和COVID-19方面面临的差异，我们研究了COVID时代结直肠癌筛查和诊断差异的变化。
在一项队列研究中，我们利用退伍军人事务医疗保健系统（VAHCS），对2018年3月1日至2021年12月31日期间每月的结肠镜检查、粪便潜血试验（FOBT）以及结直肠癌（CRC）新诊断病例进行了量化。我们比较了COVID之前（2020年3月1日之前）和COVID期间（2020年3月1日及之后）两个时期。我们按年龄、性别、种族、民族、城乡以及社会经济地位（SES）绘制了时间趋势图。在调整混杂因素后，使用逻辑回归来评估时间趋势。
在研究期间，约有90万例结肠镜检查、140万次FOBT以及超过30000例CRC新诊断病例。在COVID早期，结肠镜检查和新CRC病例分别降至COVID之前水平的<10%和<60%。尽管我们发现在COVID早期，黑人和拉丁裔患者在结肠镜检查使用方面的差异有适度增加，但在调整分析中，这些增加的差异并未持续存在。我们未发现FOBT使用差异或新CRC诊断差异的变化。
我们未发现VAHCS在CRC筛查或诊断方面，按年龄、性别、种族、民族、地理区域或SES划分的差异增加。这些结果表明了VAHCS的潜在优势，并且需要在其他癌症和医疗保健系统中进行进一步研究。
