ACTUAL VERSUS PREDICTED INCIDENCE RATES OF COLORECTAL CANCER DURING THE COVID-19 PANDEMIC: DELAY AND DISPARITY
Kelsey S. Romatoski*1,2, Sophie H. Chung1,2, Kelly Kenzik1,2, Gordana Rasic1,2, Sing Chau Ng1,2, Jennifer F. Tseng1,2, Teviah Sachs1,2
1General Surgery, Boston Medical Center, Boston, MA; 2Boston University School of Medicine, Boston, MA
Introduction: The COVID-19 pandemic has led to both direct and indirect delays in care, resulting in the disruption of many health screening services. Recent studies have demonstrated diminished screening rates for colorectal cancer. The exact impact this has had on incidence rates for colorectal cancer and possible missed diagnoses are yet unknown.
Methods: Using the National Cancer Database (NCDB), patients diagnosed with colorectal cancer from 2010-2020 were standardized to population level data, given that the NCDB represents 71.0% of colon and 75.9% of rectosigmoid cancers in the United States. This was done by utilizing the United States (US) population estimates per year per the census bureau data to calculate the annual incidence rate per 100,000. A 2010-2019 linear regression model of incidence rates (designated as pre-COVID) was used to calculate a predicted 2020 incidence rate and compare this to the actual incidence rate in 2020 (COVID). Sub-analyses were performed for patients based on age, sex, race, and geographic region.
Results: 817,652 patients were identified for analysis. After standardizing NCDB cases to US population data, the actual 2020 incidence (cases per 100,000) was 28.209 compared to the predicted 2020 incidence of 34.435, resulting in an actual incidence of 18.1% less than predicted. This effect was further amplified for patients that were male (18.6% less), black (18.8% less), and Hispanic (18.7% less), although these did not achieve significance. Patients less than 65 years old, of race other than black or white (Asian, Native Hawaiian, other Pacific Islander, American Indian), and those treated in the Western geographic region of the US had significantly lower rates of diagnosis than years prior (19.4% less, 22.1% less, and 21.9% less respectively).
Conclusion: The reported incidence of colorectal cancer significantly decreased during the COVID-19 pandemic in 2020, suggesting many patients harboring undiagnosed cancers. While the true clinical effect of COVID-19 on colorectal cancer diagnosis has yet to be seen, our data suggests missed diagnoses may drive subsequent increased incidences and higher stage at diagnosis in the coming years. In addition to the human toll, this may further burden the healthcare system and increase healthcare costs. It is imperative that providers strongly encourage patients to schedule colorectal cancer screening to flatten this pending cancer wave.
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