Study: COVID-19 Pandemic Disruptions in Cancer Screening Show Uneven Recovery in 2023

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COVID-19-related disruptions in cancer screening showed an uneven recovery in 2023 in the US, according to a new study published in JAMA. Data from the National Health Interview Survey (NHIS) indicate that while breast and colorectal cancer screening rates have rebounded above pre-pandemic levels, cervical cancer screening remains below 2019 rates.

Comparing past-year reported screening rates from 2019 to 2023, testing for cervical cancer declined by 14%, while breast cancer screening increased by 7% and colorectal cancer screening rose by 12%, reported first author Jessica Star, MA, MPH, and colleagues from the American Cancer Society in Atlanta, Georgia.

The fact that screening for breast and colorectal cancers rebounded in 2023 was encouraging, Star and colleagues wrote, but the decline in cervical cancer screening represents “a troubling trend as early-stage diagnoses continued to decrease in 2021.”

“The persistent decline may in part reflect longer-term declines in patient knowledge and clinician recommendation of cervical cancer screening,” investigators continued.

Widespread shutdowns and other disruptions during the COVID-19 pandemic resulted in delays and decreases in cancer screening, with reports of fewer early-stage cancer diagnoses and a corresponding increase in late-stage cancers, according to the study.

“To prevent further shifts toward later-stage diagnoses, efforts must address declines in cervical cancer screening and disparities by socioeconomic status in all 3 screening types,” researchers wrote. “Health systems and healthcare professionals could play a major role by improving screening communications and providing patient navigators to help address structural and cost barriers."

Star and colleagues analyzed data from the National Health Interview Survey, a nationally representative cross-sectional survey of noninstitutionalized adults. The research team assessed self-reported screening rates for breast, cervical, and colorectal cancer in 2019 (pre-pandemic), 2021 (during the pandemic), and 2023 (post-pandemic). Screening eligibility and strategies were based on the US Preventive Services Task Force recommendations put in effect in 2019.

Logistic regression models estimated adjusted prevalence ratios (aPRs) comparing cancer screening rates between 2019 to 2023 and 2021 to 2023, adjusted for age, race and ethnicity, education, insurance, and region, and stratified by education and health insurance.

Findings

Across the 3 time periods, 8888-9889 individuals were eligible for cervical cancer screening, 6829-7289 for breast cancer screening, and 12 938-13 989 for colorectal cancer screening.

Changes in reported past-year cancer screening before, during, and after the pandemic were as follows:

• Breast cancer screening (women aged 50-74 years) increased from 59.7% in 2019 to 64.9% in 2023 (aPR, 1.07; 95% CI, 1.04-1.10).
• Colorectal cancer screening (adults aged 50-75 years) rose from 21.2% in 2019 to 24.3% in 2023 (aPR, 1.12; 95% CI, 1.06-1.18). Colonoscopy rates rebounded between 2021 and 2023 (aPR, 1.13; 95% CI, 1.06-1.22), and stool-based testing remained higher than in 2019.
• Cervical cancer screening (women aged 21-65 years without hysterectomy) dropped from 46.8% in 2019 to 40.9% in 2023 (aPR, 0.86; 95% CI, 0.82-0.90), with no significant change from 2021.

Disparities in screening recovery. While breast cancer screening rebounded across education levels, increases in colorectal cancer screening were mainly observed in individuals with higher education, private insurance, or Medicare. Cervical cancer screening remained below pre-pandemic levels for most groups, despite an 8% rebound between 2021 and 2023 among college graduates.

The study had several limitations, Star and colleagues acknowledged, including the fact that survey response rates decreased over the study period (from 59.1% in 2019 to 47% in 2023), and that the data did not distinguish between colonoscopies performed for either screening, surveillance, or a diagnosis after a positive non-colonoscopy test.

Reference: Star J, Han X, Smith RA, et al. Cancer screening 3 years after the onset of the COVID-19 pandemic. JAMA. Published online March 5, 2025. doi:10.1001/jama.2025.0902