The lingering impact of the COVID-19 pandemic on colorectal cancer screening modalities and staging by neighborhood-level deprivation

Introduction: Disruptions to colorectal cancer (CRC) screenings occurred during the COVID-19 pandemic, but lingering effects and equity of this impact remain unclear. We evaluated local patterns and trends in CRC screening and cancer staging across four time periods and examined disparities by neighborhood social deprivation index (SDI). Methods: Colonoscopies, fecal immunochemical test (FIT), fecal occult blood test (FOBT), and sigmoidoscopies, were identified at our institution through the electronic medical record from March 2018 to February 2023 (n=27,946). Screenings were linked to zip code-level SDI and aggregated by month across 4 periods: pre-pandemic (March 2018-February 2020), pandemic (March 2020-February 2021), post-pandemic year 1 (March 2021-February 2022), and post-pandemic year 2 (March 2022-February 2023). ANOVAs compared monthly screening volumes and proportions from high-SDI areas across periods; chi-square tests assessed differences in cancer staging. Results: CRC screenings dropped during March-May 2020 but rebounded, resulting in no significant difference in monthly averages across periods (p =0.52). However, colonoscopies declined, whereas FIT use increased over time. The proportion of patients from high-SDI neighborhoods declined from 32.2% pre-pandemic to 28.9% by post-pandemic year 2 (p=0.002), largely driven by reduced FIT screenings among individuals from these areas (30.9% to 23.7%, p<0.0001). Later-stage diagnoses increased during the pandemic and post-pandemic year 1 but returned to baseline by year 2. Conclusion: Despite volume recovery, shifts in modality use and declining representation from high-SDI neighborhoods suggest growing disparities in CRC screening. Targeted outreach is needed to understand and address unmet screening needs, to support equitable prevention efforts moving forward.