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1.
Cancer Prev Res (Phila) ; 15(1): 1-2, 2022 01.
Article in English | MEDLINE | ID: covidwho-1613126

ABSTRACT

The First Lady of the United States, Dr. Jill Biden, visited the Hollings Cancer Center at the Medical University of South Carolina on October 25, 2021. This Commentary remarks on the administration's goal of directing public attention to cancer screening and prevention as part of an overall effort to recover ground lost in the COVID-19 pandemic, particularly in underserved communities.


Subject(s)
COVID-19/complications , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Famous Persons , Neoplasms/diagnosis , SARS-CoV-2/isolation & purification , COVID-19/virology , Humans , Neoplasms/epidemiology , Neoplasms/prevention & control , Neoplasms/virology , United States
2.
CMAJ Open ; 9(4): E1205-E1212, 2021.
Article in English | MEDLINE | ID: covidwho-1592340

ABSTRACT

BACKGROUND: Breast cancer screening in Ontario, Canada, was deferred during the first wave of the COVID-19 pandemic, and a prioritization framework to resume services according to breast cancer risk was developed. The purpose of this study was to assess the impact of the pandemic within the Ontario Breast Screening Program (OBSP) by comparing total volumes of screening mammographic examinations and volumes of screening mammographic examinations with abnormal results before and during the pandemic, and to assess backlogs on the basis of adherence to the prioritization framework. METHODS: A descriptive study was conducted among women aged 50 to 74 years at average risk and women aged 30 to 69 years at high risk, who participated in the OBSP. Percentage change was calculated by comparing observed monthly volumes of mammographic examinations from March 2020 to March 2021 with 2019 volumes and proportions by risk group. We plotted estimates of backlog volumes of mammographic examinations by risk group, comparing pandemic with prepandemic screening practices. Volumes of mammographic examinations with abnormal results were plotted by risk group. RESULTS: Volumes of mammographic examinations in the OBSP showed the largest declines in April and May 2020 (> 99% decrease) and returned to prepandemic levels as of March 2021, with an accumulated backlog of 340 876 examinations. As of March 2021, prioritization had reduced the backlog volumes of screens for participants at high risk for breast cancer by 96.5% (186 v. 5469 expected) and annual rescreens for participants at average risk for breast cancer by 13.5% (62 432 v. 72 202 expected); there was a minimal decline for initial screens. Conversely, the backlog increased by 7.6% for biennial rescreens (221 674 v. 206 079 expected). More than half (59.4%) of mammographic examinations with abnormal results were for participants in the higher risk groups. INTERPRETATION: Prioritizing screening for those at higher risk for breast cancer may increase diagnostic yield and redirect resources to minimize potential long-term harms caused by the pandemic. This further supports the clinical utility of risk-stratified cancer screening.


Subject(s)
Breast Neoplasms/diagnosis , COVID-19/epidemiology , Early Detection of Cancer , Guideline Adherence/statistics & numerical data , Mammography , Aged , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Early Detection of Cancer/statistics & numerical data , Female , Health Priorities/standards , Health Priorities/statistics & numerical data , Humans , Mammography/standards , Mammography/statistics & numerical data , Middle Aged , Ontario/epidemiology , Risk Factors
3.
Cancer Prev Res (Phila) ; 14(10): 919-926, 2021 10.
Article in English | MEDLINE | ID: covidwho-1450634

ABSTRACT

The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.


Subject(s)
COVID-19/complications , Cytodiagnosis/methods , Early Detection of Cancer/methods , Papillomaviridae/isolation & purification , Papillomavirus Infections/complications , SARS-CoV-2/isolation & purification , Uterine Cervical Neoplasms/diagnosis , Brazil/epidemiology , DNA, Viral/analysis , DNA, Viral/genetics , Female , Humans , Papillomavirus Infections/genetics , Papillomavirus Infections/virology , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/virology
5.
Comput Math Methods Med ; 2021: 9998379, 2021.
Article in English | MEDLINE | ID: covidwho-1314186

ABSTRACT

In recent years, computerized biomedical imaging and analysis have become extremely promising, more interesting, and highly beneficial. They provide remarkable information in the diagnoses of skin lesions. There have been developments in modern diagnostic systems that can help detect melanoma in its early stages to save the lives of many people. There is also a significant growth in the design of computer-aided diagnosis (CAD) systems using advanced artificial intelligence. The purpose of the present research is to develop a system to diagnose skin cancer, one that will lead to a high level of detection of the skin cancer. The proposed system was developed using deep learning and traditional artificial intelligence machine learning algorithms. The dermoscopy images were collected from the PH2 and ISIC 2018 in order to examine the diagnose system. The developed system is divided into feature-based and deep leaning. The feature-based system was developed based on feature-extracting methods. In order to segment the lesion from dermoscopy images, the active contour method was proposed. These skin lesions were processed using hybrid feature extractions, namely, the Local Binary Pattern (LBP) and Gray Level Co-occurrence Matrix (GLCM) methods to extract the texture features. The obtained features were then processed using the artificial neural network (ANNs) algorithm. In the second system, the convolutional neural network (CNNs) algorithm was applied for the efficient classification of skin diseases; the CNNs were pretrained using large AlexNet and ResNet50 transfer learning models. The experimental results show that the proposed method outperformed the state-of-art methods for HP2 and ISIC 2018 datasets. Standard evaluation metrics like accuracy, specificity, sensitivity, precision, recall, and F-score were employed to evaluate the results of the two proposed systems. The ANN model achieved the highest accuracy for PH2 (97.50%) and ISIC 2018 (98.35%) compared with the CNN model. The evaluation and comparison, proposed systems for classification and detection of melanoma are presented.


Subject(s)
Diagnosis, Computer-Assisted/methods , Melanoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Algorithms , Artificial Intelligence , Computational Biology , Databases, Factual/statistics & numerical data , Deep Learning , Dermoscopy , Diagnosis, Computer-Assisted/statistics & numerical data , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , Humans , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Image Interpretation, Computer-Assisted/statistics & numerical data , Neural Networks, Computer , Skin Diseases/classification , Skin Diseases/diagnostic imaging
6.
PLoS One ; 16(7): e0253493, 2021.
Article in English | MEDLINE | ID: covidwho-1298079

ABSTRACT

OBJECTIVE: To validate the colposcopy indication proposed by the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests (the 2019 ASCCP guidelines). METHODS: Clinical data of 1404 patients who underwent colposcopy in single center in China were reviewed. Based on history and current cervical screening (HPV & cytology), corresponding recommendations were given according to the 2019 ASCCP guidelines. The agreement and discrepancy of colposcopy indication were analyzed between the Chinese consensus and the 2019 ASCCP guidelines. RESULTS: Colposcopy indication was matched in about 80% patients. The left 20% were recommended with follow-up by the 2019 ASCCP guidelines. The discrepancy mainly focused on patients having a current result of HPV-positive NILM without unknown history. The ratio of observed CIN3+ in our database over estimated CIN3+ by the 2019 ASCCP guidelines was 6.2 (31/5). The ratio was even higher in patients with HPV16/18-positive NILM (7, 28/4), compared with those with other types of high-risk HPV-positive NILM (3, 3/1). The 2019 ASCCP guidelines had a relatively high sensitivity (83.1%), a low specificity (21.5%), a low positive predictive value (14.1%) and a high negative predictive value (89.1%) for prediction of CIN 3+. CONCLUSIONS: We could try to apply the 2019 ASCCP guidelines in Chinese population. The classification of HR-HPV was strongly recommended during risk assessment. For patients with HPV16/18 infection, colposcopy should be recommended. Perspective multi-center randomized controlled trial with reliable follow-up should be performed in the future to confirm the feasibility.


Subject(s)
Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy/standards , Early Detection of Cancer/methods , Guidelines as Topic , Uterine Cervical Neoplasms/diagnosis , Adult , Cervical Intraepithelial Neoplasia/pathology , China , Female , Human papillomavirus 16/isolation & purification , Human papillomavirus 18/isolation & purification , Humans , Mass Screening/methods , Papillomavirus Infections/pathology , Retrospective Studies , Risk , Uterine Cervical Neoplasms/pathology
7.
BJS Open ; 5(4)2021 07 06.
Article in English | MEDLINE | ID: covidwho-1297380

ABSTRACT

BACKGROUND: COVID-19 has brought an unprecedented challenge to healthcare services. The authors' COVID-adapted pathway for suspected bowel cancer combines two quantitative faecal immunochemical tests (qFITs) with a standard CT scan with oral preparation (CT mini-prep). The aim of this study was to estimate the degree of risk mitigation and residual risk of undiagnosed colorectal cancer. METHOD: Decision-tree models were developed using a combination of data from the COVID-adapted pathway (April-May 2020), a local audit of qFIT for symptomatic patients performed since 2018, relevant data (prevalence of colorectal cancer and sensitivity and specificity of diagnostic tools) obtained from literature and a local cancer data set, and expert opinion for any missing data. The considered diagnostic scenarios included: single qFIT; two qFITs; single qFIT and CT mini-prep; two qFITs and CT mini-prep (enriched pathway). These were compared to the standard diagnostic pathway (colonoscopy or CT virtual colonoscopy (CTVC)). RESULTS: The COVID-adapted pathway included 422 patients, whereas the audit of qFIT included more than 5000 patients. The risk of missing a colorectal cancer, if present, was estimated as high as 20.2 per cent with use of a single qFIT as a triage test. Using both a second qFIT and a CT mini-prep as add-on tests reduced the risk of missed cancer to 6.49 per cent. The trade-off was an increased rate of colonoscopy or CTVC, from 287 for a single qFIT to 418 for the double qFIT and CT mini-prep combination, per 1000 patients. CONCLUSION: Triage using qFIT alone could lead to a high rate of missed cancers. This may be reduced using CT mini-prep as an add-on test for triage to colonoscopy or CTVC.


Subject(s)
COVID-19 , Colorectal Neoplasms/diagnosis , Diagnostic Errors/statistics & numerical data , Occult Blood , Triage/organization & administration , Clinical Audit , Colonoscopy , Decision Trees , Early Detection of Cancer/methods , Humans , Scotland , Sensitivity and Specificity , Tomography, X-Ray Computed
8.
J Natl Cancer Inst ; 113(6): 662-664, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1249307

ABSTRACT

These past months of the coronavirus disease-2019 (COVID-2019) pandemic have given us ample opportunity to reflect on the US health-care system. Despite overwhelming tragedy, it is an opportunity for us to learn and to change. As we postpone routine visits because of the pandemic, we worry about risks for patients who delay cancer screening. We use cervical cancer screening and prevention as an example of how we can use some "lessons learned" from the pandemic to prevent "collateral losses," such as an increase in cancers. COVID-2019-related health-system changes, like the more rapid evaluation of diagnostic tests and vaccines, the transition to compensated virtual care for most counseling and education visits, and broadened access to home services, offer potential benefits to the delivery of cervical cancer screening and prevention. While we detail the case for cervical cancer prevention, many of the issues discussed are generalizable to other preventative measures. It would be a tragedy if the morbidity and mortality of COVID-2019 are multiplied because of additional suffering caused by delayed or deferred cancer screening and diagnostic evaluation-but maybe with creativity and reflection, we can use this pandemic to improve care.


Subject(s)
COVID-19 , Early Detection of Cancer/methods , Uterine Cervical Neoplasms/prevention & control , Female , Humans , SARS-CoV-2
9.
Womens Health (Lond) ; 17: 17455065211017070, 2021.
Article in English | MEDLINE | ID: covidwho-1242233

ABSTRACT

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented upheaval within global healthcare systems and resulted in the temporary pausing of the National Health Service (NHS) Scotland Cervical Screening Programme. With several months of backlogs in appointments, there has not only been a reduction in primary samples being taken for human papilloma virus (HPV) testing but there have also been fewer women referred to colposcopy for investigation and treatment of precancerous or cancerous changes as a result. Encouraging uptake for cervical screening was always a priority before the pandemic, but it is even more important now, considering that the fears and barriers to screening that women may have are now exacerbated by COVID-19. OBJECTIVES: This article explores the impact of the pandemic on the uptake of cervical screening within NHS Ayrshire & Arran and evaluates potential strategies to improve uptake now and in future such as self-sampling and telemedicine. METHODS: This article presents evidence-based literature and local health board data relating to cervical screening during the pandemic. RESULTS: Human papilloma virus self-sampling carried out by the woman in her home has been shown to improve uptake, especially in non-attenders, whilst maintaining a high sensitivity and, crucially, reducing the need for face-to-face contact. Increased education is key to overcoming barriers women have to screening and telemedicine can strengthen engagement with women during this time. CONCLUSION: There are lessons to be learned from the pandemic, and we must use this opportunity to improve cervical screening uptake for the future.


Subject(s)
Early Detection of Cancer/methods , Mass Screening/methods , Mass Screening/statistics & numerical data , Papillomaviridae , Self Care , Uterine Cervical Neoplasms/prevention & control , Adult , Appointments and Schedules , COVID-19/epidemiology , Cervical Intraepithelial Neoplasia/prevention & control , Colposcopy , Female , Humans , Middle Aged , Papanicolaou Test , Scotland/epidemiology , Vaginal Smears
11.
JAMA Netw Open ; 4(4): e216454, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1176229

ABSTRACT

Importance: COVID-19 has decreased colorectal cancer screenings. Objective: To estimate the degree to which expanding fecal immunochemical test-based colorectal cancer screening participation during the COVID-19 pandemic is associated with clinical outcomes. Design, Setting, and Participants: A previously developed simulation model was adopted to estimate how much COVID-19 may have contributed to colorectal cancer outcomes. The model included the US population estimated to have completed colorectal cancer screening pre-COVID-19 according the American Cancer Society. The model was designed to estimate colorectal cancer outcomes between 2020 and 2023. This analysis was completed between July and December 2020. Exposures: Adults screened for colorectal cancer and colorectal cancer cases detected by stage. Main Outcomes and Measures: Estimates of colorectal cancer outcomes across 4 scenarios: (1) 9 months of 50% colorectal cancer screenings followed by 21 months of 75% colorectal cancer screenings; (2) 18 months of 50% screening followed by 12 months of 75% screening; (3) scenario 1 with increased use of fecal immunochemical tests; and (4) scenario 2 with increased use of fecal immunochemical tests. Results: In our simulation model, COVID-19-related reductions in care utilization resulted in an estimated 1 176 942 to 2 014 164 fewer colorectal cancer screenings, 8346 to 12 894 fewer colorectal cancer diagnoses, and 6113 to 9301 fewer early-stage colorectal cancer diagnoses between 2020 and 2023. With an abbreviated period of reduced colorectal cancer screenings, increasing fecal immunochemical test use was associated with an estimated additional 588 844 colorectal cancer screenings and 2836 colorectal cancer diagnoses, of which 1953 (68.9%) were early stage. In the event of a prolonged period of reduced colorectal cancer screenings, increasing fecal immunochemical test use was associated with an estimated additional 655 825 colorectal cancer screenings and 2715 colorectal cancer diagnoses, of which 1944 (71.6%) were early stage. Conclusions and Relevance: These results suggest that the increased use of fecal immunochemical tests during the COVID-19 pandemic was associated with increased colorectal cancer screening participation and more colorectal cancer diagnoses at earlier stages. If our estimates are borne out in real-world clinical practice, increasing fecal immunochemical test-based colorectal cancer screening participation during the COVID-19 pandemic could mitigate the consequences of reduced screening rates during the pandemic for colorectal cancer outcomes.


Subject(s)
COVID-19/complications , Colorectal Neoplasms/diagnosis , Early Detection of Cancer/standards , Outcome Assessment, Health Care/standards , Adult , COVID-19/prevention & control , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care/statistics & numerical data , Pandemics/prevention & control , Pandemics/statistics & numerical data , Risk Factors , United States
15.
Dig Liver Dis ; 53(6): 682-688, 2021 06.
Article in English | MEDLINE | ID: covidwho-1120261

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has had a huge impact on healthcare systems, resulting in many routine diagnostic procedures either being halted or postponed. AIMS: To evaluate whether the diagnoses of colorectal, gastric and pancreatic cancers have been impacted by the SARS-CoV-2 pandemic in Italy. METHODS: A survey designed to collect the number of histologically-proven diagnoses of the three cancers in gastroenterology services across Italy from January 1 to October 31 in 2017-2020. Non-parametric ANOVA for repeated measurements was applied to compare distributions by years and macro-areas. RESULTS: Compared to 2019, in 2020 gastric cancer diagnoses decreased by 15.9%, CRC by 11.9% and pancreatic by 9.9%. CRC distributions showed significant differences between all years, stomach cancer between 2018 and 2020 and 2019-2020, and pancreatic cancer only between 2017 and 2019. The 2019-2020 comparison showed fewer CRC diagnoses in the North (-13.7%), Center (-16.5%) and South (-4.1%), fewer stomach cancers in the North (-19.0%) and South (-9.4%), and fewer pancreatic cancers in the North (-14.1%) and Center (-4.7%), with an increase in the South (+12.3%). Distributions of CRC and gastric cancer were significantly different between all years in the North. CONCLUSIONS: This survey highlights the concerning effects of the COVID-19 pandemic on the diagnostic yield of gastroenterology services for stomach, colorectal and pancreatic cancers in Italy.


Subject(s)
COVID-19 , Delivery of Health Care , Digestive System Neoplasms , Early Detection of Cancer , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Diagnostic Techniques, Digestive System , Digestive System Neoplasms/diagnosis , Digestive System Neoplasms/epidemiology , Early Detection of Cancer/methods , Early Detection of Cancer/trends , Gastroenterology/methods , Gastroenterology/statistics & numerical data , Humans , Infection Control/methods , Italy/epidemiology , Organizational Innovation , SARS-CoV-2 , Surveys and Questionnaires
16.
Future Oncol ; 17(10): 1197-1207, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1112570

ABSTRACT

Aims: To evaluate the efficacy of TruScreen (TS01) for high-risk human papillomavirus (HR-HPV) women compared with other methods in reducing colposcopy referral rates in hospitals. Methods: A single-center, prospective, case-control study was conducted from December 2019 to June 2020. Results: Among 139 (46.2%) HR-HPV-positive patients, 58 were CIN1, 52 were CIN2-3 and 29 had cervical cancer (n = 29). The sensitivity and specificity of detecting CIN2+ by TS01, colposcopy and HPV16/18 testing were 96.3% and 46.4%, 85.2% and 40.5% and 59.3% and 74.1%, respectively. The highest sensitivity was 96.3% at HPV16/18 and TS01 (each positive results), and the highest specificity was 83.6% at HPV16/18 and TS01 (both positive) for CIN2+ compared with the other methods. Conclusion: TS01 is a noninvasive screening method and can be used to diagnose cervical lesions quickly. It is especially suitable as triage tool for HR-HPV-positive women facing SARS-CoV-2 exposure and infection risks in hospital.


Subject(s)
COVID-19/epidemiology , Cervical Intraepithelial Neoplasia/diagnosis , Early Detection of Cancer/methods , Papillomavirus Infections/complications , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Colposcopy , Female , Humans , Middle Aged , Prospective Studies , Sensitivity and Specificity , Triage/methods , Young Adult
18.
Int J Cancer ; 149(1): 97-107, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1086364

ABSTRACT

We conducted a study to document the impact of COVID-19 pandemic on cancer screening continuum in selected low- and middle-income countries (LMICs). LMICs having an operational cancer control plan committed to screen eligible individuals were selected. Managers/supervisors of cancer screening programs were invited to participate in an online survey and subsequent in-depth interview. Managers/supervisors from 18 programs in 17 countries participated. Lockdown was imposed in all countries except Brazil. Screening was suspended for at least 30 days in 13 countries, while diagnostic-services for screen-positives were suspended in 9 countries. All countries except Cameroon, Bangladesh, India, Honduras and China managed to continue with cancer treatment throughout the outbreak. The participants rated service availability compared to pre-COVID days on a scale of 0 (no activities) to 100 (same as before). A rating of ≤50 was given for screening services by 61.1%, diagnostic services by 44.4% and treatment services by 22.2% participants. At least 70% participants strongly agreed that increased noncompliance of screen-positive individuals and staff being overloaded or overwhelmed with backlogs would deeply impact screening programs in the next 6 months at least. Although many of the LMICs were deficient in following the "best practices" to minimize service disruptions, at least some of them made significant efforts to improve screening participation, treatment compliance and program organization. A well-coordinated effort is needed to reinitiate screening services in the LMICs, starting with a situational analysis. Innovative strategies adopted by the programs to keep services on-track should be mutually shared.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Early Detection of Cancer/statistics & numerical data , Neoplasms/diagnosis , SARS-CoV-2/isolation & purification , Surveys and Questionnaires/statistics & numerical data , Bangladesh , Brazil , COVID-19/epidemiology , COVID-19/virology , Cameroon , China , Cross-Sectional Studies , Developing Countries , Early Detection of Cancer/methods , Honduras , Humans , India , Neoplasms/therapy , Pandemics , SARS-CoV-2/physiology
19.
Lancet Gastroenterol Hepatol ; 6(3): 199-208, 2021 03.
Article in English | MEDLINE | ID: covidwho-1065697

ABSTRACT

BACKGROUND: There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. METHODS: Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated. FINDINGS: As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020. INTERPRETATION: The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England. FUNDING: Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.


Subject(s)
COVID-19 , Colonoscopy/statistics & numerical data , Colorectal Neoplasms , Colorectal Surgery/statistics & numerical data , Early Detection of Cancer , Patient Care Management , Radiotherapy/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/therapy , Delivery of Health Care/trends , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , England/epidemiology , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/standards , Referral and Consultation/statistics & numerical data , SARS-CoV-2 , State Medicine
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