The COVID-19 pandemic led to a drastic reduction in lung cancer screening, but the rate of decline was similar between Whites and non-Whites and between rural and nonrural populations. All groups saw their rates of lung cancer screening (LCS) return to near prepandemic levels by June 2020, according to a new analysis of two academic and two community imaging sites in North Carolina.
The study was led by Louise Henderson, PhD, of the Lineberger Comprehensive Cancer Center, and M. Patricia Rivera, MD, FCCP, of the department of medicine, division of pulmonary disease and critical care medicine, both at the University of North Carolina at Chapel Hill. The findings appeared online in Chest.
“I am [not] surprised by the decline, but I am certainly reassured,” Abbie Begnaud, MD, FCCP, said in an interview. Dr. Begnaud is assistant professor of medicine at the University of Minnesota, Minneapolis. She was not involved in the study.
Dr. Abbie Begnaud
Dr. Begnaud said that the findings were similar to what she has seen at her own institution. Although the rebound in screening was good to see, it nevertheless suggests that screening is still lagging. “During the ramp-up period, they got back to nearly prepandemic levels, but you might have liked to see that the numbers were even higher. In theory, if you had several months of people who should have been getting screened who didn’t, if they were all getting caught up, you might have seen higher numbers after that,” said Dr. Begnaud.
The current winter surge in cases is likely to have long-lasting impact on lung cancer screening as well. Although she hasn’t seen a similar decline yet, Dr. Begnaud expects it’s coming. “I think we’ll see a major decline even throughout this year in screening until we are squarely out of the pandemic.” Things could be particularly challenging for resource-poor settings. “If physical resources (CT scanners) and human resources (techs, radiologists, primary care providers) are overworked, they may not have the bandwidth for ‘elective’ and preventive care,” said Dr. Begnaud.
Two previous studies looked at changes in lung cancer screening after the onset of the pandemic, but neither examined patient characteristics or risk factors. The current study included 3,688 screening exams (52.3% first-time exams), and divided them up into the pre-COVID-19 era (Jan. 1 to March 2, 2019), the beginning of the pandemic (March 3 to March 29, 2020), the shutdown period (March 30 to May 21, 2020) and the ramp-up period (May 22 to Sept. 30, 2020).
The largest reduction of screening volume occurred during the beginning of the pandemic, at –33.6% (95% confidence interval, –11.9% to –55.3%). By June, the reduction in volume was –9.1%, compared with pre-COVID-19 levels (95% CI, –4.7% to –23.0%). In the period between June and September 2020, the overall rate was similar to pre-COVID-19 levels (–15.3% change; 95% CI, –7.8% to 38.4%).
The researchers found no differences in screening changes among patient groups based on age, sex, race, smoking status, body mass index, COPD status, hypertension, or patient residence. The proportion of exams that were first-time screens was highest before the pandemic (53.8%), and declined at the beginning of the pandemic (50.7%), during shutdown (49.7%), and during the ramp-up period (48.6%). The difference between the prepandemic and ramp-up period in terms of first-time screens was statistically significant (P = .0072).
The investigators offered a couple of caveats: “Our results do not demonstrate differences in LCS volumes pre- versus during COVID among non-White patients or rural patients, both of which have persistently experienced disparities in lung cancer outcomes and other cancer screening modalities. Additionally, our results do not suggest that patients at high risk of COVID complications (i.e., patients who are obese, have COPD or hypertension) were less likely to undergo LCS.” The study demonstrated, rather, that a similar impact of the COVID-19 crisis on lung cancer screening was felt across all patient subgroups.
The study was funded by The National Cancer Institute. Dr. Rivera served as an advisory board member for Biodesix and bioAffinity Technologies, and served on an advisory research panel for Johnson & Johnson. Dr. Begnaud has no relevant financial disclosures.