Cancer screenings haven’t rebounded to pre-pandemic levels

Fewer people are getting screened for common cancers compared to pre-pandemic levels, and the declines are most notable in Asian, Black and Hispanic adults, according to a new study.

Fewer patients are getting screened for breast cancer and other cancers compared to pre-pandemic levels, according to a new study. (Image credit: ©lordn - stock.adobe.com)

In a study of more than 89,000 adults, cancer screenings continue to trail pre-COVID levels. Other preventive visits have yet to rebound as well. The findings were published Friday by Jama Health Forum.

Disturbingly, researchers found large declines among Asian, Black and Hispanic adults in cancer screenings.

“Given that we found racial and ethnic minority populations received the fewest preventive screenings in 2019, a slower recovery from disruptions in these services during the pandemic may worsen health care disparities in future years,” the researchers wrote. “These findings highlight the urgent need for concerted health system, public health, and health policy efforts to increase preventive screenings among eligible U.S. adults.”

Across all racial groups, fewer people were getting screened for breast, colorectal, cervical and prostate cancers, the study says.

Declines vary by racial groups

Researchers from Beth Israel Deaconess Medical Center and Harvard Medical School produced the study. They examined cancer screening levels in 2019 and 2021.

While researchers found a drop in breast cancer screenings among all adults, the largest declines were among Hispanic women, followed by Asian adults.

Fewer women were screened for cervical cancer, but the largest decline was seen among Asian adults, according to the study.

In colorectal cancer screenings, researchers found the largest drop was among Black Americans in 2021, compared with 2019. Asian adults also had a noteworthy decline in screenings.

Fewer men were getting screened for prostate cancer in 2021, compared to 2019. The biggest decline in screenings was seen in Asian adults, researchers found.

Researchers found sharp drops in cancer screenings early in the pandemic, including a study published in Cancer in March 2022. The declines in screenings prompted some concerns about seeing sicker patients in hospitals and patients showing more advanced cancers that weren’t detected earlier.

Concerns about loss of coverage

Researchers also expressed concern about the prospect of millions of Americans losing Medicaid coverage, now that states have more flexibility to determine eligibility for the program aimed at providing care for those with lower incomes. Earlier in the pandemic, states were barred from trimming their Medicaid coverage as a condition of getting federal Covid funding, but those restrictions are no longer in effect.

More than 16 million Americans have been dropped from Medicaid coverage, according to a KFF analysis.

With fewer people having Medicaid, the authors of the new study said it’s possible that fewer people will get screened for cancer or other health issues.

“Given that Black and Hispanic adults, as well as some Asian subgroups, are more likely to receive coverage through Medicaid compared with White adults, loss of Medicaid coverage may exacerbate declines in wellness visits and preventive screenings in future years,” the authors wrote.

Researchers also found fewer outpatient wellness visits in 2021 and 2022, compared to 2019.

Adults were also less likely to undergo preventive screenings to check blood pressure, blood glucose, and cholesterol, researchers found. Again, Asian Americans had the biggest drops in screenings for risk factors for cardiovascular disease.

Potential factors in declines

Researchers say the declines in cancer and other wellness screenings could be tied to backlogs from earlier in the pandemic, with some patients finding it harder to get appointments. Some may have deferred screenings due to concerns of contracting COVID-19, researchers said.

Researchers also said the rise in the use of telehealth could be a factor. While researchers noted that telehealth offers increased access and convenience, they said it’s also correlated with declines in preventive care, since virtual visits entail additional laboratory visits for screening tests.

At least in 2021 and 2022, researchers found financial barriers to screenings actually decreased, compared to 2019. But researchers also warned of looming hurdles with fewer Americans being covered by Medicare.

The study on screenings comes just a few weeks after the American Cancer Society posted new data showing more younger Americans are being diagnosed with cancer.

Black patients also continue to have higher mortality rates in many cancers, pointing to the need for screenings to detect cancers at earlier stages.

Healthcare leaders have hailed some positive steps for cancer screenings. The U.S. Preventive Services Task Force said women should begin getting screened for breast cancer at the age of 40. The Food and Drug Administration has adopted new regulations requiring providers to notify women who get mammograms if they have dense breast tissue, which increases the risk of breast cancer.

Critics faulted one key element of the task force recommendations for breast cancer screenings, which advise women to get checked every other year. Many, such as Nina Vincoff, the chief of breast imaging at Northwell Health, urge women to be screened annually.

“When we screen every year, we increase the chances that we're going to find breast cancers when they're smaller and easier to treat,” Vincoff told Chief Healthcare Executive® in an October 2023 interview.

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