Past

Colorectal cancer (CRC) is the third most common cancer in the United States. Given the efficacy of screening for early detection,1 the U.S. Preventive Services Task Force recommends screening for adults aged 45–74 years.2 The COVID-19 pandemic disrupted healthcare delivery, including cancer screening.3 Various policies were implemented to mitigate COVID-19 transmission, which affected primary healthcare services and altered cancer screening practices.4 Despite the easing of restrictions, screening for cancers did not fully recover post-pandemic with vulnerable populations possibly at higher risk for suboptimal screening.5 To date, the impact of the pandemic on CRC screening, particularly among socially vulnerable individuals, remains poorly defined. We sought to characterize CRC screening utilization during the pandemic, as well as post-pandemic return of screening practices relative to county-level SVI and race/ethnicity in a nationally representative cohort.6

Present

Among 10,503,180 individuals continuously enrolled in Medicare with no previous diagnosis of CRC, 1,362,457 (12.97%) underwent CRC screening between 2019–2021. With the COVID-19 pandemic, CRC screening decreased markedly across the United States (median monthly screening: pre-pandemic n = 76,444 vs. pandemic n = 60,826; median Δn = 15,618; p < 0.001). One-year post-pandemic, overall CRC screening utilization generally rebounded to pre-COVID-19 levels (monthly median screening volumes: pandemic, n = 60,826, vs. post-pandemic, n = 74,170; median Δn = 13,344; p < 0.001). Individuals residing in counties with the highest SVI experienced the largest decline in CRC screening odds relative to individuals residing in low SVI counties (reference: low SVI; pre-pandemic: high SVI OR 0.85; pandemic: high SVI OR 0.81; post-pandemic: high SVI OR 0.85; all p < 0.001).

Future

Cancer screening can be impacted by social determinants of health, including race/ethnicity and social vulnerability. Perhaps not surprising, there was a much lower utilization of CRC during the COVID-19 pandemic. Of more interest was the finding that screening did not rebound to pre-pandemic levels equally among the U.S. population; rather, racial/ethnic minority patients, as well as individuals living in vulnerable areas, experienced a persistent lower chance to have CRC screening post-pandemic. These data serve to highlight how social inequities not only differentially impacted healthcare delivery during the pandemic, but also how these disparities persisted post-pandemic. Focused efforts to coordinate healthcare delivery systems, as well as increase utilization of telehealth services/mobile screening services are needed to address cancer screening disparities.