ABSTRACT
BACKGROUND AND AIM: Colorectal cancer (CRC) screening reduces CRC mortality by early detection and CRC incidence by polypectomy. Kaiser Permanente Northern California (KPNC) initiated organized CRC screening in 2006 using annual mailed fecal immunochemi-cal test (FIT) screening and opportunistic colonoscopy, with high screening rates. Public health guidance related to the COVID-19 pandemic led to elective colonoscopies and mailed FIT outreach being paused in March 2020. This study evaluated the impact of the pandemic on CRC screening at KPNC. METHODS: For January-December 2019 and January-October 2020, we evaluated: the KPNC screening-eligible population aged 50-75;those up to date with screening due to colonoscopy;eligible for a FIT;mailed a FIT kit;completed a FIT;completed a follow-up colonoscopy after a positive FIT;completed a colonoscopy unrelated to a positive FIT;and up to date with screening by end of follow-up (i.e., 2019 and end of October 2020, respectively). RESULTS: There were 913,873 and 941,763 eligible members in 2019 and 2020;151,252 (16.6%) and 150,407 (16.0%) were up to date with screening due to prior colonoscopy, leaving 762,621 and 791,356 eligible for FIT, respectively. Compared to 2019, when FIT kits were mailed to 627,260 of 762,621 (82.3%) FIT-eligible members, FIT kits were mailed to 521,239 of 791,356 (65.9%) eligible members by the end of October 2020, with mailings ongoing. Declines in FIT mailings occurred in March-May 2020 but rebounded quickly thereafter (Fig 1a). FIT kits were returned by 504,152 of 762,621 (66.1%) members in 2019, and 365,972 of 791,356 (46.2%) members through October 2020, with lower returns in March-June 2020 (Fig 1b). In 2019, 11,119 of 15,402 (72.2%) FIT-positive patients received a follow-up colonoscopy by year end, and through October 2020, 6,856 of 10,922 (62.8%) received a follow-up colonoscopy after a positive FIT (Fig 1c). Another 14,420 of 762,621 (1.9%) and 9,902 of 791,356 (1.3%) members completed a colonoscopy during 2019 and 2020, respectively (Fig 2). By the end of 2019, 665,541 of 913,873 (72.8%) were up to date with screening, and through October 2020, 522,215 of 941,763 (55.5%) were up to date with screening (Fig 2). CONCLUSION: The COVID-19 pandemic resulted in temporary delays in the mailing and return of FITs;and a reduction in colonoscopies performed, due, in part, to patient reluctance to respond to FIT outreach or complete follow-up colonoscopy during the pandemic. Also, fewer individuals were up to date with screening, although outreach continues through December 2020. The organized mailed FIT program allowed for the rapid resumption of outreach;however, follow-up is needed to assess the impact of screening delays on CRC outcomes and to identify ways to improve adherence with FIT screening, including colonoscopy follow-up after a positive FIT.(Figure presented) (Figure presented) (Figure presented) (Figure presented)