The impact of the COVID-19 pandemic on the screening and surveillance of colorectal cancer (CRC) was discussed during a breakout session called “Endoscopic Screening and Surveillance in Colorectal Cancer—What’s New?” .
Dr John Carethers (University of Michigan, MI, USA) said that there are 9 or more options for CRC screening but that colonoscopy is the only available option for surveillance. “Colonoscopy is the dominant strategy for CRC screening in the USA and patients need to visit their healthcare facility to get this procedure done.”
The COVID-19 pandemic is associated with a significant reduction in cancer care, especially when it comes to performed breast cancer screenings and CRC screenings, which dropped with 89.2% and 84.5% in April 2020, respectively. “The estimated increase of cancer deaths due to the screening shutdown is approximately 1,000 individuals per year if the screening trajectory recovers within 6–12 months. However, this number may be up to 10,000 if cancer screening remains deficient.” Dr Carethers said that the consequences are likely to be worse in underserved populations, such as African-Americans, since these populations are disproportionally affected by COVID-19.
Efforts have been made to overcome the reduced screening capacity by developing non-invasive home screening tests. These screening options include direct visualisation and measurements of protein, DNA, RNA, low molecular weight metabolites, or shifts in gut microbiome. “mSEPT9 is the first blood-based test that has been approved by the FDA, displaying a sensitivity of 70% for CRC and 27% for advanced adenomatous polyps,” said Dr Carethers. “However, most tests are still under investigation.” Although at-home CRC screening is cheap, some patients have difficulty correctly completing these tests. Moreover, the accuracy needs to be improved, especially for adenoma detection. “Also, patients still require a colonoscopy if they have a positive at-home test.”
Dr Carethers concluded by arguing that preventive healthcare should not be delayed just because of COVID-19, since excessive delay will cost lives.
- Carethers JM, et al. Impact of COVID-19 on Screening and Diagnosis. Breakout Session: Endoscopic Screening and Surveillance in Colorectal Cancer—What’s New? ASCO GI 2022, 20–22 January.
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