US Cancer Screening Recommendations: Developments and the Impact of COVID-19

Abstract

The USPSTF and ACS recommend screening for breast, cervical, colorectal, and lung cancers. Rates of cancer screening, diagnosis, and treatment decreased significantly in the US and other developed nations during the height of the COVID-19 pandemic and lockdown (April 2020) and have since recovered, although not to baseline levels in many cases. For breast cancer, the USPSTF recommends biennial screening with mammography for women aged 50−74, while the ACS recommends annual screening for women aged 45−54, who may transition to biennial after 55. Minority and rural populations have lower rates of screening and lower utilization of DBT, which offers superior sensitivity and specificity. Among 20 US health networks in April 2020, mammography rates were down 89.2% and new breast cancer diagnoses down by 50.5%. For cervical cancer, the USPSTF recommends cervical cytology every three years for women 21−65, or cytology+hrHPV co-testing every five years for women aged 30−65. Cervical cancer screening rates declined by 87% in April 2020 and recovered to a 40% decline by June 2020, with American Indians and Asians most severely affected. For colorectal cancer (CRC), the USPSTF and ACS recommend screening for ages 45−75, recently lowered from a starting age of 50. Most commonly-used modalities include annual FIT testing, FIT+DNA testing every three years, and colonoscopy every ten years, with shorter repeat if polyps are found. In the US, CRC screenings were down by 79−84.5% in April 2020 across several retrospective studies. Patient encounters for CRC were down by 39.9%, and a UK-based model predicted that 5-year-survival would decrease by 6.4%. The USPSTF recommends screening low dose CT scans (LDCTs) for ages 50−80 with a >20 pack-year smoking history who have smoked within the past 15 years. In April 2020, screening LDCTs fell by 72−78% at one US institution and lung cancer diagnoses were down 39.1%.

Keywords: COVID-19; USPSTF; cancer screening; pandemic; prevention.

Figure 1

Decline in cancer screening rates during the peak of the COVID-19 pandemic. Data from “Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters.” JCO Clin. Cancer Informatics (2020).

Figure 2

Decline in patient encounters during COVID-19 pandemic by cancer type. Data from “Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters.” JCO Clin. Cancer Informatics (2020).