Prostate Cancer Screening during the Covid-19 Pandemic across Demographic Groups

ABSTRACT

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic led to the delay of routine medical care, including cancer screening, beginning in March of 2020. While screening rates for several cancers, including prostate cancer, rapidly recovered after the first wave of the COVID-19 pandemic, the degree to which this recovery was realized in different populations remains unknown. We sought to determine the association of the COVID-19 pandemic with prostate cancer screening, particularly for traditionally underserved patients. METHOD(S) We performed a retrospective cohort study using electronic health records (EHR) data from the Optum EHR database for male patients between the ages of 55-69 eligible for prostate cancer screening from quarter 1 (Q1) of 2016 through Q2 of 2021. We excluded men with a prior diagnosis of prostate cancer. We performed multivariable analysis to estimate screening over time, adjusting for patient age, race, ethnicity, Census division of residence, and insurance status. RESULT(S) A total of 7,361,765 patients were included. After adjusting for patient demographics, the percentage of eligible patients with prostate cancer screening decreased from 2.2% in Q4 of 2019 to 1.3% in Q2 of 2020. There was a rebound in screening to 2.4% in Q3 of 2020, which is similar to baseline levels, and a subsequent decline to 1.6% in Q2 of 2021. This trend was seen even after stratifying based on age, race, ethnicity, division, and insurance status (Figure 1). CONCLUSION(S) A 40% decline in prostate cancer screening in Q2 of 2020 was observed during the first wave of the pandemic. This returned to baseline by Q3 of 2020. Subsequent decline was seen again through Q2 of 2021, which also coincides with the second wave of COVID-19. This trend was unaffected by patient characteristics, such as age, race, insurance status, or division of residence. While these data suggest that the peak of the pandemic impacted prostate cancer screening trends similarly across different patient demographic groups, further study is required to breakdown if this was due to social distancing, decreased clinic volumes, or other factors.