Initial and persistent changes in cancer screening in a US Midwestern community health center network following the onset of COVID-19

Objective: To assess longer-term change in breast, cervical, and colorectal cancer screening among Community Health Centers (CHCs) following onset of COVID-19. Methods: Among 27 CHCs in the US Midwest, we examine trends in standard electronic clinical quality measures and test-volume based cancer screening measures from January 2019 through October 2021. Test-volume measures include the number of cancer screening tests completed, the difference between the actual versus expected cumulative number of tests completed (i.e. pandemic screening gap), and the recent testing ratio (i.e. proportion of individuals up-to-date on screening who completed testing in the past year). Results: Standard cancer screening quality measures showed only modest changes. In contrast, test-volume measures show large and persistent deficits. After a sharp drop in screening activity in early 2020, activity resumed but failed to reach pre-pandemic levels. As a result, the pandemic screening gap continued to grow larger over time reaching approximately 5400 fewer breast, 8600 fewer cervical, and 4500 fewer colorectal cancer screenings performed. This represents a 16-18 % deficit in the number of tests and is the equivalent of 3.5-4.0 months of dedicated pre-pandemic cancer screening activity. The recent testing ratio also decreased in 2020 and also failed to return to pre-pandemic levels. Conclusions: Following onset of COVID-19, there was a persistent negative change in cancer screening in our CHC network. This change is more evident when examining test-volume compared to standard quality metrics. Understanding and addressing the persistent pandemic cancer screening gap is critical to limit health burdens and disparities related to cancer.