Recovery From COVID-19-Related Disruptions in Cancer Detection

Abstract

Importance: The COVID-19 pandemic impacted the timely diagnosis of cancer, which persisted as the second leading cause of death in the US throughout the pandemic.

Objective: To evaluate the disruption and potential recovery in cancer detection during the first (2020) and second (2021) years of the COVID-19 pandemic.

Design, setting, and participants: This cross-sectional study involved an epidemiologic analysis of nationally representative, population-based cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Included patients were diagnosed with incident cancer from January 1, 2000, through December 31, 2021. The analysis was conducted in May 2024 using the April 2024 SEER data release, which includes incidence data through December 31, 2021.

Exposures: Diagnosis of cancer during the first 2 years of the COVID-19 pandemic (2020, 2021).

Main outcomes and measures: Difference between the expected and observed cancer incidence in 2020 compared with 2021, with additional analyses by demographic subgroups (sex, race and ethnicity, and age group) and community (county-level) characteristics.

Results: The analysis included 15 831 912 patients diagnosed with invasive cancer between 2000 and 2021, including 759 810 patients in 2020 and 825 645 in 2021. The median age was 65 years (IQR, 56-75 years), and 51.0% were male. The percentage difference between the expected and observed cancer incidence was -8.6% (95% CI, -9.1% to -8.1%) in 2020, with no significant difference in 2021 (-0.2%; 95% CI, -0.7% to 0.4%). These translated to a cumulative (2020-2021) deficit in observed vs expected cases of -127 931 (95% CI, -139 206 to -116 655). Subgroup analyses revealed that incidence rates remained substantially depressed from expected rates into 2021 for patients living in the most rural counties (-4.9%; 95% CI, -6.7% to -3.1%). The cancer sites with the largest cumulative deficit in observed vs expected cases included lung and bronchus (-24 940 cases; 95% CI, -28 936 to -20 944 cases), prostate (-14 104 cases; 95% CI, -27 472 to -736 cases), and melanoma (-10 274 cases; 95% CI, -12 825 to -7724 cases).

Conclusions and relevance: This cross-sectional study of nationally representative registry data found that cancer incidence recovered meaningfully in 2021 following substantial disruptions in 2020. However, incidence rates need to recover further to address the substantial number of patients with undiagnosed cancer during the pandemic.

Figure.. US Cancer Incidence From 2000 to 2021 and During Peripandemic Years 2018 to 2021

Observed total cancer cases in the US were extrapolated from Surveillance, Epidemiology, and End Results Program data, and cancer incidence rates were modeled using joinpoint trend modeling. A and B, Solid lines indicate modeled trend and dashed lines, projected incidence. B, Error bars indicate 95% CIs for observed incidence and shading, 95% CIs for modeled trend and projected incidence. C and D, Bars indicate observed cases and dotted line, projected cases.