Late-stage colorectal, breast cancer diagnoses increase after start of COVID-19 pandemic

The percentage of patients presenting with late-stage breast and colorectal cancers increased between 2019 and 2020 at Moores Cancer Center at University of California San Diego Health, according to data published in JAMA Network Open.

Researchers additionally observed a decrease in early-stage presentation of these cancer types during the same period.

Rationale and methods

“We decided to look into data of breast and colon cancer stages at presentation at our institution since we noticed, anecdotally, that many patients were canceling or postponing procedures, such as colonoscopies,” Jade Z. Zhou, MD, PhD, researcher at Moores Cancer Center at University of California San Diego Health, told Healio. “As the pandemic continued, it seemed that an increasing number of our new patient consults were metastatic cancers.”

Zhou and colleagues assessed cancer staging among patients who presented with a first diagnosis of malignant neoplasms or a second opinion during 2019 and 2020.

Researchers used the American Joint Committee on Cancer staging module to determine stage at presentation and compared the stage distribution at presentation in 2019 vs. 2020 for all cancer types, and specifically for breast and colorectal cancers (n = 522; mean age, 58.1 years; 89.5% women). They then compared the proportions of stage I or stage IV breast cancer, colorectal cancer and all cancers between 2019 and 2020 using the Fisher exact test.

Key findings

Results showed 1,894 new patient visits for malignant neoplasms occurred in 2019 compared with 1,915 in 2020.

All patients with cancer had similar overall stage distribution, with 31.9% of patients with stage I disease in 2019 compared with 29% in 2020 (OR = 1.15; 95% CI, 1-1.32) and 26% of patients with stage IV disease in 2019 compared with 26.4% in 2020 (OR = 0.98; 95% CI, 0.84-1.13).

Among patients who presented with colorectal cancer, researchers found 17.8% of patients had stage I disease in 2019 compared with 14.6% in 2020 (OR = 1.26; 95% CI, 0.34-4.88). Conversely, 6.7% of patients presented with stage IV colon cancer in 2019 compared with 19.5% in 2020 (OR = 0.3; 95% CI, 0.05-1.37).

For breast cancer, 63.9% of patients presented with stage I disease in 2019 compared with 51.3% in 2020 (OR = 1.67; 95% CI 1.13-2.47), and 1.9% presented with stage IV disease in 2019 compared with 6.2% in 2020 (OR = 0.33; 95% CI, 0.09-0.98).

Researchers noted that data for January through March 2021 showed a continued trend toward fewer patients presenting with stage I disease and more patients presenting with stage IV disease (41.9% vs. 8%).

“We observed a statistically significant increase in new stage IV breast cancer cases seen at our institution in 2020 after the pandemic compared with 2019, whereas we saw a decrease in new stage I breast cancer cases with the total number of new patients remaining the same,” Zhou said.

“A similar trend was seen with new patients with colorectal cancer; however, this was not statistically significant,” she added. “We were not particularly surprised by the trend, but the extent of change was surprising. In particular, the percentage of new patients with stage IV breast cancer had tripled in 2020 compared with 2019.”

Implications

Zhou said the results highlight the importance of preventive care.

“We need to continue counseling patients on the importance of screening procedures such as colonoscopies and mammograms so that we can catch these cancers at an early, curable stage,” Zhou said. “It would be interesting to continue following this data in future years, particularly as some late diagnoses due to delayed screening may not have presented yet. We also hope to collaborate with other cancer centers to determine whether this is a continuing trend across other institutions and allow analysis for further demographic and regional trends.”

For more information:

Jade Z. Zhou, MD, PhD, can be reached at Moores Cancer Center at University of California San Diego Health, 3855 Health Sciences Drive, MC 0829, La Jolla, CA 92093; email: jzzhou@health.ucsd.edu.