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Rebound in Fecal Testing, Colonoscopy Utilization, and Colorectal Neoplasia Detection During the COVID-19 Pandemic
Michael J Langevin1, Christopher D Jensen2, Amy R Marks2
1Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
The American Journal of Gastroenterology
|January 6, 2025
Summary
Colorectal cancer (CRC) screening dropped during the pandemic but rebounded strongly in 2021. Most patient groups recovered screening rates, showing resilience in CRC testing post-pandemic.
Area of Science:
- Oncology
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic significantly disrupted routine cancer screenings, including colorectal cancer (CRC) screening.
- Limited data exists on the recovery of CRC testing rates and neoplasia detection post-pandemic.
Purpose of the Study:
- To evaluate the utilization of CRC screening tests and the detection of colorectal neoplasia in a large health system during and after the COVID-19 pandemic.
- To compare screening and detection rates in 2020-2021 against pre-pandemic (2019) levels.
- To identify any disparities in screening recovery among different demographic subgroups.
Main Methods:
- Retrospective cohort study design.
- Analysis of fecal immunochemical test (FIT) and colonoscopy utilization, FIT positivity, and neoplasia detection rates.
- Data collected annually from 2019 to 2021 for screening-eligible patients (aged 50-75) at Kaiser Permanente Northern California.
- Stratification of data by sex, age, race/ethnicity, and preferred spoken language.
Main Results:
- A significant reduction in CRC testing (FIT and colonoscopy), FIT positivity, and neoplasia detection was observed in 2020 compared to 2019.
- A strong rebound in CRC screening and neoplasia detection occurred in 2021, approaching or exceeding 2019 levels.
- Most demographic subgroups, including racial/ethnic minorities and language preference groups, showed comparable recovery rates in 2021.
- White individuals and those with an English language preference experienced a slight lag in recovery to baseline screening levels.
Conclusions:
- CRC screening and neoplasia detection demonstrated a robust recovery in 2021 following pandemic-related declines.
- The study suggests that health systems can recover screening rates effectively after major disruptions, with minimal long-term disparities observed in this cohort.
- Further long-term research is necessary to ascertain the ultimate impact of pandemic-induced screening changes on future CRC outcomes.
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