Rebound in Fecal Testing, Colonoscopy Utilization, and Colorectal Neoplasia Detection During the COVID-19 Pandemic

The COVID-19 pandemic reduced colorectal cancer (CRC) screening, but the rebound in testing and outcomes after the pandemic has not been widely reported. We evaluated CRC test utilization and colorectal neoplasia detection among screening eligible patients in a large health system in 2020 and 2021, compared with 2019 (prepandemic).

Using a retrospective cohort study design, fecal immunochemical test (FIT) and colonoscopy utilization, FIT positivity, and neoplasia detection were evaluated annually in 2019-2021 among Kaiser Permanente Northern California patients aged 50-75 years overall and by sex, age, race and ethnicity, and spoken language preference.

Compared with 2019, reductions in FIT, colonoscopy, FIT positivity, and neoplasia detection in 2020 were followed by a strong rebound in 2021 and no subgroups by age and sex or minority subgroups by race and ethnicity or spoken language preference demonstrably lagged in their recovery in 2021. Among White persons and those with an English language preference, there was a small lag in recovery to baseline levels. The overall decline in CRC testing by colonoscopy in 2020 was offset by a lesser decrease in FIT utilization in 2020, and a strong rebound in FIT utilization in 2021 helped to offset the small lag in the rebound in colonoscopies completed in 2021.

Findings may help guide organizations looking to improve CRC screening and minimize health care disparities related to national emergencies such as pandemics. Long-term studies are needed to evaluate how pandemic-related changes in CRC screening practices will affect future CRC outcomes.