Cancer Diagnosis Lags Have Continued 2 Years into the Pandemic

January 23, 2023 - A recent study published in the Journal of Clinical Oncology by researchers from Quest Diagnostics found that cancer diagnoses are still lagging in the United States despite being two years into the COVID-19 pandemic. The study looked at new cancer diagnoses pre-pandemic and throughout three defined periods of the pandemic for eight different cancers: prostate, breast, colorectal, pancreatic, cervical, gastric, and esophageal cancers. The trends in cancer diagnoses highlight a significant gap in patient care which may be rectified through provider efforts and community outreach.

Study Trends and Explanations

Yuri Fesko, MD, Vice President of Medical Affairs at Quest Diagnostics, and co-author of this study, explained that looking back at the heart of the pandemic in 2020, the healthcare industry saw declines in cancer diagnosis, specifically the five most common cancers.

Based on data from patients who received testing at Quest Diagnostics during the pre-pandemic period — from January 2019 to February 2020 — 184,999 people were diagnosed with prostate cancer. That number drastically decreased during Pandemic Period 1 (March–May 2020), when there were only 29,118 diagnoses. While increasing to 131,797 by Pandemic Period 3 (April 2021–March 2022), the rates are not nearly as high as expected. This trend is similar among each of the eight cancers analyzed.

It is easy to mistake this fact for good news, assuming that reduced diagnoses mean reduced cancer rates; however, Fesko — and many other healthcare professionals — have gathered data explaining that it is not the case. 

“Thinking back to that time, there were stay-at-home orders. It was difficult to access the hospital, and many non-urgent procedures were put off,” clarified Fesko. “Because of that, we hypothesized that not as many people are getting their screenings and getting a diagnosis.”

Based on these assumptions, Fesko and other healthcare professionals assumed that there would be a rise in cancer diagnoses in 2021 and 2022 as restrictions were lifted. However, data from his study found that these rates were not rising as anticipated.

“The healthcare system saw some increase in cancer diagnoses but not enough to compensate for all those missing patients during 2020 and parts of 2021,” he added. “That indicates to us that many patients out in the community likely have a cancer present that just hasn't been diagnosed.”

The results of this study and similar studies imply that many patients have advanced-stage cancer that has not been diagnosed yet, meaning that it could be incurable by surgery alone, metastasize, and require chemotherapy. These outcomes are unfavorable, as they increase patient risk and reduce the quality of life.

Causes of Diagnostic Lags

Understanding the trends in diagnosis rates and what that may mean for patients is critical; however, understanding the underlying causes that have contributed to a delayed cancer diagnosis is equally as crucial as it may offer insight into potential solutions.

One of the primary reasons Fesko attributes to these trends is the decline in preventative care appointments, where most patients would get or be advised to get screened for cancers for which they are at risk.

“Healthcare professionals had seen that many primary care visits were put off, particularly during the pandemic. People are slowly getting back to their physician, but we are seeing that it's getting better,” he told LifeSciencesIntelligence.

While returning to regular preventive care checkups is necessary, providers are dealing with many backlogged screenings, including mammograms and colonoscopies, that had been put off during the pandemic. Fesko notes that dealing with the backlog of patients and the ongoing burden of the pandemic has put the healthcare system under extreme pressure.

“Many nurses have burnt out,” he emphasized. “Physicians have burnt out and left the profession, putting further pressure on the folks left in the system. That all starts to contribute to the delays.”

Improving Access to Screenings

Despite many people beginning to return to their preventative care appointments, Fesko notes that a subset of the population has not made their way back into the primary care provider’s office. He explained that his organization, like many other organizations, has been working diligently to ensure they reach all patient populations, especially the ones at higher risk of missing a screening and coming in with late-stage cancer.

“Historically, there have been underserved populations that have lower rates of screening colonoscopies, PSA testing, and breast cancer screening,” began Fesko. “Although Quest hasn’t done a formal study to see if that is the population that's most at risk, we have done several outreach programs and are trying to reach those populations.”

Fesko revealed that many of these patients had been hit especially hard by the pandemic, and historic mistreatment has fostered distrust between them and the healthcare industry. Beyond distrust, systemic and systematic barriers prevent patients from getting timely screenings.

“These patient populations may be working multiple jobs and having difficulty taking time off from work to be able to do any of these things. They're the hardest ones to reach,” noted Fesko. “They would also be the most at risk of coming in with an advanced stage because of these factors. And they're the ones that many of the programs we work with have been targeting.”

Education and Community Outreach

Like many others, Fesko detailed that reaching the community begins with advocacy catered to that community. This may mean holding screenings or educational events at community groups, churches, and more. A critical part of encouraging early screenings is emphasizing that screenings can improve outcomes by catching illness earlier.

Fesko notes that one of the best strategies is to have an advocate from the community impacted by the screening talk to community members. This conversation solidifies the need for screening, bringing real-world implications to the forefront of the community’s minds.

Bringing Screenings to Patients

Education and awareness are critical tools for ensuring timely screenings and encouraging patients to get screened; however, education alone is insufficient. Fesko notes that it only works if, simultaneously, the more concrete barriers to access are taken down.

In practice, this may mean getting patients to make an appointment or connecting them with a suitable facility. In many cases, screenings can be done in a mobile clinic.

“Those services can be brought to the community,” said Fesko. “Bringing it to the patients brings down those barriers to access care.”

The Role of Liquid Biopsy in Cancer Screening

Another tool that may help improve diagnostic rates is a liquid biopsy. Fesko notes that liquid biopsy has shown great promise as a screening tool for general cancer and disease-specific screenings. These tests are blood-based, hopefully increasing the compliance rate as it is a bit more convenient and less invasive than other screenings, such as colonoscopy for colon cancer.

Accuracy and Sensitivity Concerns

“One of the challenges with liquid biopsy is how it can detect cancer when it's still in the early phase. What healthcare providers don't want to find is that we switch to a blood-based test and have stage migration where patients present with something that requires a more invasive surgery because we caught it a little later. And that's one of the challenges that we are working on is making sure that we pick it up certainly at those earlier stages,” added Fesko.

“These are screening tests and not diagnostic tests. So they are picking up people with a very high chance of having cancer but still have to undergo a proper diagnostic workup to diagnose them with something that's either pre-cancerous or cancerous,” Fesko told LifeSciencesIntelligence.

This means patients who screen negatively can go about their daily lives, while patients who screen positive would undergo additional workups to confirm the presence of cancer. 

“The pandemic was awful, but it pointed out many deficiencies within our healthcare system in terms of everything, from the convenience of being able to go to the doctor to amplifying these problems with underserved populations,” concluded Fesko. “It is something that needed to come to light, and hopefully, it's getting the attention that it needs so that we can provide a large portion of the population with screening procedures that will move the needle.”