How COVID-19 Impacted Colonoscopy Utilization and Colorectal Cancer Detection in Hawai'i in 2020

Area of Science:

• Oncology
• Public Health
• Gastroenterology

Background:

• The COVID-19 pandemic significantly disrupted healthcare services, including cancer screening and diagnosis.
• Colorectal cancer (CRC) screening rates, particularly colonoscopies, saw a notable decline during the pandemic due to lockdowns and patient-related fears.
• Previous research documented decreased colonoscopy rates nationally, but the impact on Hawai'i's unique demographics remained unstudied.

Purpose of the Study:

• To assess the pandemic's effect on colonoscopy services and colorectal neoplasia detection in Hawai'i.
• To analyze CRC case demographics (age, sex, ethnicity) in relation to pandemic-induced screening changes.
• To identify specific populations disproportionately impacted by reduced CRC screening and diagnosis.

Main Methods:

• Retrospective analysis of colonoscopy procedures and CRC diagnoses from major outpatient endoscopy centers in Hawai'i.
• Comparison of data from 2020 (pandemic year) against 2019 (pre-pandemic baseline).
• Stratification of new CRC cases by patient demographics including age, sex, and ethnicity.

Main Results:

• A significant decrease in the number of colonoscopies performed in 2020 compared to 2019 was observed.
• There was a disproportionately larger reduction in diagnosed colorectal cancer cases during the pandemic period.
• Elderly males and individuals identifying as Native Hawaiian/Pacific Islander experienced the most substantial decrease in CRC detection.

Conclusions:

• The COVID-19 pandemic negatively impacted CRC screening via colonoscopy in Hawai'i, leading to fewer diagnoses.
• Specific demographic groups, including elderly males and Native Hawaiians/Pacific Islanders, were disproportionately affected by reduced CRC detection.
• There is a potential for increased late-stage CRC presentation and mortality among these vulnerable populations due to delayed diagnosis.