Screenings for Cancer, Other Preventive Visits Continue to Lag Post-Pandemic

Fewer people are getting screened for common cancers compared to prepandemic levels, and the declines are most notable in Asian, Black and Hispanic adults, according to a new study.

Using data from the National Health Interview Survey 2021-2022 for more than 89 000 adults, researchers found that cancer screenings continue to trail pre-COVID levels. Other preventive visits have yet to rebound as well, according to the findings, published February 2, 2024 in JAMA Health Forum.

_{©okrasniuk/stock.adobe.com}

“Given that we found racial and ethnic minority populations received the fewest preventive screenings in 2019, a slower recovery from disruptions in these services during the pandemic may worsen health care disparities in future years,” the researchers wrote. “These findings highlight the urgent need for concerted health system, public health, and health policy efforts to increase preventive screenings among eligible U.S. adults.”

Across all racial groups, fewer people were getting screened for breast, colorectal, cervical and prostate cancers, the study says.

Declines vary by race/ethnicity

When the researchers, from Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston, MA, examined cancer screening levels in 2019 and 2021, they found a significant drop in breast cancer screenings among all adults. The largest declines, however, were among Hispanic women, followed by all Asian adults. They also reported fewer screenings among women for cervical cancer, with the largest decline seen among Asian women.

In colorectal cancer screenings, researchers found the largest drop was among Black Americans in 2021, compared with 2019. They also reported noteworthy declines in these screenings among Asian adults.

Among men, there were fewer being screened for prostate cancer in 2021, compared to 2019 and, once again, the most pronounced decline was seen in Asian adults, researchers found.

Researchers found sharp drops in cancer screenings early in the pandemic, as reported in the journal Cancer in March 2022. The declines in screenings prompted some concerns about the severity of illness seen in persons hospitalized for cancer because that may have been avoided.

Public payers cutting coverage

Researchers also expressed concern about the prospect of millions of Americans losing Medicaid coverage, now that states have more flexibility to determine eligibility for the program aimed at providing care for those with lower incomes. Earlier in the pandemic, states were barred from trimming their Medicaid coverage as a condition of getting federal COVID funding, but those restrictions are no longer in effect.

More than 16 million Americans have been dropped from Medicaid coverage, according to a KFF analysis. The current study’s authors fear losing this coverage will further reduce screenings for cancer and other dangerous disease.

“Given that Black and Hispanic adults, as well as some Asian subgroups, are more likely to receive coverage through Medicaid compared with White adults, loss of Medicaid coverage may exacerbate declines in wellness visits and preventive screenings in future years,” the authors wrote.

Researchers also found fewer outpatient wellness visits in 2021 and 2022, compared to 2019. Preventive screenings for a wide range of disease risk factors also declined, including surveillance of blood pressure, blood glucose, and cholesterol. Again, Asian Americans had the biggest drops in screenings for risk factors for cardiovascular disease.

Potential factors in declines

Researchers say the declines in cancer and other wellness screenings could be tied to backlogs from earlier in the pandemic, with some people finding it harder to get appointments. Some may have deferred screenings due to concerns of being exposed to COVID-19, they added.

The rapid rise in the use of telehealth also may play a role. While the remote option offers increased access and convenience, it is also correlated with declines in preventive care, since in-person visits may entail additional laboratory visits for screening tests.

The study on screenings comes just a few weeks after the American Cancer Society posted new data showing more younger Americans are being diagnosed with cancer.

Mortality among Black individuals from many cancers also continues at higher levels, pointing to a need for earlier detection through screening.

Healthcare leaders have hailed some positive steps for cancer screenings. The U.S. Preventive Services Task Force said women should begin getting screened for breast cancer at the age of 40. The Food and Drug Administration has adopted new regulations requiring providers to notify women who get mammograms if they have dense breast tissue, which increases the risk of breast cancer.

Critics faulted one key element of the task force recommendations for breast cancer screenings, which advise women to get checked every other year. Many, such as Nina Vincoff, the chief of breast imaging at Northwell Health, urge women to be screened annually.

“When we screen every year, we increase the chances that we're going to find breast cancers when they're smaller and easier to treat,” Vincoff told Chief Healthcare Executive® in an October 2023 interview.

This review originally appeared on partner site Chief Healthcare Executive and has been lightly edited.