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. 2020 Nov;13(11):893-896.
doi: 10.1158/1940-6207.CAPR-20-0447. Epub 2020 Sep 17.

Disparities in Cancer Prevention in the COVID-19 Era

John M Carethers  1 , Rajarshi Sengupta  2 , Rea Blakey  3 , Antoni Ribas  4 , Gypsyamber D'Souza  5
Affiliations

Disparities in Cancer Prevention in the COVID-19 Era

John M Carethers et al. Cancer Prev Res (Phila). 2020 Nov.

Abstract

Screening for cancer is a proven and recommended approach to prevent deaths from cancer; screening can locate precursor lesions and/or cancer at early stages when it is potentially curable. Racial and ethnic minorities and other medically underserved populations exhibit lower uptake of cancer screening than nonminorities in the United States. The COVID-19 pandemic, which disproportionately affected minority communities, has curtailed preventive services including cancer screening to preserve personal protective equipment and prevent spread of infection. While there is evidence for a rebound from the pandemic-driven reduction in cancer screening nationally, the return may not be even across all populations, with minority population screening that was already behind becoming further behind as a result of the community ravages from COVID-19. Fear of contracting COVID-19, limited access to safety-net clinics, and personal factors like, financial, employment, and transportation issues are concerns that are intensified in medically underserved communities. Prolonged delays in cancer screening will increase cancer in the overall population from pre-COVID-19 trajectories, and elevate the cancer disparity in minority populations. Knowing the overall benefit of cancer screening versus the risk of acquiring COVID-19, utilizing at-home screening tests and keeping the COVID-19-induced delay in screening to a minimum might slow the growth of disparity.

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Conflict of interest statement

No potential conflicts of interest were disclosed by the other authors.

Figures

Figure 1.
Figure 1.
Rates for screening for breast cancer and colorectal cancer based on level of income. Data obtained from Siegel and colleagues (9) and White and colleagues (10). FPL, federal poverty level.
Figure 2.
Figure 2.
Scenarios for cancer prevention after COVID-19 surges. Scenario A indicates a rapid recovery under 1 year with fairly rapid clearance of the backlog. Scenario B depicts a delayed return to historical screening trends over 1–3 years, with a much longer clearance of backlog over several years. Scenario C depicts a situation in which we never get back to historical trends, creating a public health crisis. Delays in returning to baseline or higher levels of screening with reverse gains, causing additional preventable deaths from cancer. Estimates for excess deaths are from a baseline of delay of 6-months for breast and colorectal cancers as modeled in Sharpless (12).
Figure 3.
Figure 3.
Benefits versus risks of cancer screening during the COVID-19 pandemic.
See this image and copyright information in PMC

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