Examining the Association Between the COVID-19 Pandemic and the Rate of Diagnostic Tests for Breast, Cervical, and Colorectal Cancer in Manitoba, Canada

Author:

Decker Kathleen M.123ORCID,Musto Grace3,Bucher Oliver3,Czaykowski Piotr245,Hebbard Pamela6,Kim Julian O.178,Singh Harminder124,Thiessen Maclean45,Feely Allison3,Galloway Katie3,Lambert Pascal13

Affiliation:

1. Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada

2. Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

3. Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada

4. Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

5. Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada

6. Department of Surgery, Section of General Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

7. Department of Radiology, Section of Radiation Oncology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

8. Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada

Abstract

Background: Strategies to minimize the impact of the COVID-19 pandemic led to a reduction in diagnostic testing. It is important to assess the magnitude and duration of this impact to plan ongoing care and avoid long-lasting impacts of the pandemic. Objective: We examined the association between the COVID-19 pandemic and the rate of diagnostic tests for breast, cervical, and colorectal cancer in Manitoba, Canada. Design and Participants: A population-based, cross-sectional study design with an interrupted time series analysis was used that included diagnostic tests from January 1, 2015 until August 31, 2022. Setting: Manitoba, Canada. Main Outcomes: Outcomes included mammogram, breast ultrasound, colposcopy, and colonoscopy rates per 100,000. Cumulative and percent cumulative differences between the fitted and counterfactual number of tests were estimated. Mean, median, and 90th percentile number of days from referral to colonoscopy date by referral type (elective, semiurgent, urgent) were determined. Results: In April 2020, following the declaration of the COVID-19 public health emergency, bilateral mammograms decreased by 77%, unilateral mammograms by 70%, breast ultrasounds by 53%, colposcopies by 63%, and colonoscopies by 75%. In Winnipeg (the largest urban center in the province), elective and semiurgent colonoscopies decreased by 76% and 39%, respectively. There was no decrease in urgent colonoscopies. As of August 2022, there were an estimated 7270 (10.7%) fewer bilateral mammograms, 2722 (14.8%) fewer breast ultrasounds, 836 (3.3%) fewer colposcopies, and 11 600 (13.8%) fewer colonoscopies than expected in the absence of COVID-19. As of December 2022, in Winnipeg, there were an estimated 6030 (23.9%) fewer elective colonoscopies, 313 (2.6%) fewer semiurgent colonoscopies, and 438 (27.3%) more urgent colonoscopies. Conclusions: In Manitoba, the COVID-19 pandemic was associated with sizable decreases in diagnostic tests for breast, colorectal, and cervical cancer. Two and a half years later, there remained large cumulative deficits in bilateral mammograms, breast ultrasounds, and colonoscopies.

Funder

CancerCare Manitoba Foundation

Research Manitoba

Canadian Institutes of Health Research

Publisher

SAGE Publications

Reference41 articles.

1. Cancer incidence during the COVID‐19 pandemic by region of residence in Manitoba, Canada: A cancer registry‐based interrupted time series study

2. Trends of COVID-19 incidence in Manitoba and public health measures: March 2020 to February 2022

3. Manitoba Health Epidemiology and Surveillance Unit. Provincial COVID-19 and Seasonal Influenza Surveillance - 2022-2023 - Week 44 Winnipeg, Manitoba: Government of Manitoba; 2022 [Oct 2, 2023]; Available from: https://www.gov.mb.ca/health/publichealth/surveillance/covid-19/index.html.

4. Estimating the Burden of Disease

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