Impact of COVID-19 on cancer screening in South Korea

Abstract

The coronavirus disease (COVID-19) pandemic significantly declined cancer screening rates worldwide. Its impact on the South Korean population is unclear, depending on socioeconomic status (SES), residence, and history of chronic disease. This study utilized data (2018-2020) from the Korean National Cancer Screening Survey, an annual cross-sectional study employing nationally representative random sampling. Cancer screening rates were defined as the proportion of the eligible population who received respective cancer screening within the last 1 year and investigated four major cancers (stomach, colorectal, breast, and cervical). Screening rates every year were compared with screening rate ratios (SRRs) and the corresponding 95% confidence intervals (CIs). Between 2019 and 2020, screening rates declined significantly by 23%, 17%, 12%, and 8% for colorectal cancer (SRR 0.77; 95% CI 0.73-0.82), stomach cancer (SRR 0.83; 95% CI 0.79-0.87), breast cancer (SRR 0.88; 95% CI 0.82-0.93), and cervical cancer (SRR 0.92; 95% CI 0.87-0.97), respectively. Regardless of cancer type, screening was significantly lower in metropolitan residents, those with higher SES, and, interestingly, those without a history of chronic diseases. The significant decline in cancer screening during the pandemic requires urgent political intervention to reduce the burden of future cancer incidence and mortality.

Figure 1

Latest cancer screening rates within the last 1 year for the period 2016–2020. The cancer screening rates were measured according to cancer screening protocols issued by the NCSP of Korea: Stomach, Percentage of adults aged $\ge$ 40 years who underwent stomach cancer screening using either UGIS or endoscopy. Colorectum, Percentage of adults aged $\ge$ 50 years who underwent colorectal cancer screening using FIT. Breast, Percentage of women aged $\ge$ 40 years who underwent breast cancer screening using mammography. Cervix, Percentage of women aged $\ge$ 20 years who underwent cervical cancer screening using conventional cytology. Weighting values from the Population and Housing Census were applied to calculate the screening rates. UGIS, gastrointestinal series; FIT, fecal immunochemical test.