• The COVID-19 pandemic has disrupted cancer screening programs, such as mammograms and colonoscopies, and this may have led to an increase in late-stage cancer diagnoses during the pandemic 
• Zhou et al. (JAMA Network Open, 2022) compared the incidence of early- and late-stage breast and colorectal cancer diagnoses during vs before the COVID-19 pandemic  

• Quality improvement study  
• Participants 
  • All patients presenting to a cancer center for a new diagnosis of malignant neoplasm or a second opinion  
• Exposures 
  • Presentation in 2019 
  • Presentation in 2020 
• Study design 
  • Fisher exact test used to compare the proportions of stage I or stage IV of cancers between 2019 and 2020 
• Primary outcome 
  • Stage distribution at presentation for  
    • Cancer overall 
    • Colorectal cancer 
    • Breast cancer 

• Men: 55 | Women: 476  
  • Mean age: 58.1 (SD, 13.5) years 
• The total number of new patient visits for malignant neoplasm was similar in 2019 and 2020 
  • In 2019: 1894 visits 
  • In 2020: 1915 visits 

Overall Cancer  

• The overall stage distribution for all patients with cancer was similar 
  • Stage I  
    • In 2019: 31.9% of patients 
    • In 2020: 29.0% of patients 
    • OR 1.15 (95% CI, 1.00 to 1.32); P=0.05 
  • Stage IV 
    • In 2019: 26.0% of patients 
    • In 2020: 26.4% of patients 
    • OR 0.98 (95% CI, 0.84 to 1.13); P=0.77 

Colorectal Cancer  

• After the start of the COVID-19 pandemic, there was no significant decrease in colorectal cancer  
  • Stage I 
    • In 2019: 17.8% 
    • In 2020: 14.6% 
    • OR 1.26 (95% CI, 0.34 to 4.88); P=0.78 
  • Stage IV 
    • In 2019: 6.7% 
    • In 2020: 19.5%  
    • OR 0.3 (95% CI, 0.05 to 1.37); P=0.11 

Breast Cancer  

• Among patients with breast cancer, a lower percentage of patients presented with stage I disease in 2019 vs 2020 
  • In 2019: 63.9% 
  • In 2020: 51.3% 
  • OR 1.67 (95% CI, 1.13 to 2.47); P=0.008 
• There was a significantly higher number of patients presenting with stage IV breast cancer in 2020 
  • In 2019: 1.9% 
  • In 2020: 6.2% 
  • OR 0.33 (95% CI, 0.09 to 0.98); P=0.04 
• Recent data for January through March 2021 demonstrate a continuing trend of a lower percentage of patients with breast cancer presenting with stage I disease and a higher percentage presenting with stage IV disease 
  • Stage I: 41.9% 
  • Stage IV: 8.0% 

• The percentage of patients presenting with stage IV breast cancer increased in 2020, compared to before the COVID-19 pandemic 
• Limitations include a single center study | Study design addresses associations but not causality | Colorectal cancer cases were limited 
• The authors state 

There is increasing concern regarding the effect of the COVID-19 pandemic on cancer mortality, as the evidence suggests that the number of patients presenting at late, incurable stages is increasing. Patients who have delayed preventative care during the pandemic should be encouraged to resume treatment as soon as possible 

Comparison of Early- and Late-Stage Breast and Colorectal Cancer Diagnoses During vs Before the COVID-19 Pandemic 

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