Abstract
Background:
COVID-19 disrupted cancer-related care in early 2020.
Methods:
We used population-based cancer registry data to estimate incidence and mortality rates of GI cancers between 2016 and 2020.
Results:
Incidence rates were unchanged from 2016 to 2019 but decreased in 2020, with the largest declines for colorectal cancer (RR 0.88; 95%CI 0.87, 0.90) and hepatocellular carcinoma (RR 0.85; 95%CI 0.82, 0.88). Mortality rates of colorectal cancer (RR 1.06; 95%CI 1.04, 1.08) and esophageal adenocarcinoma (RR 1.06; 95%CI 1.00, 1.13) increased in 2020.
Conclusion:
Incidence and mortality rates of GI cancers may increase in the future given pandemic-related delays in 2020.
Keywords: COVID-19, incidence, population-based, mortality
Introduction
The COVID-19 pandemic disrupted clinical practice, leading to unprecedented declines in cancer-related care. The AGA, AASLD, ACG, and ASGE jointly recommended suspending non-urgent endoscopic procedures in March 2020.1 Many imaging centers experienced similar declines in diagnostic capacity, and others elected to also suspend non-invasive screening tests.2 These disruptions had consequences across the entire cancer continuum: screening, timely follow-up and diagnosis, and receipt of guideline-concordant treatment.3, 4
Modeling studies conducted during the initial stages of the pandemic projected a decrease in cancer diagnoses, particularly early-stage diagnoses, from 2020 to 2023.5 However, due to a two-year lag in reporting to population-based cancer registries, the actual impact of the pandemic on cancer incidence and mortality rates in the U.S. has not been previously observed. To address this gap, we report incidence and mortality rates of gastrointestinal (GI) cancers in 2020.
Methods
We used data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program to estimate age-adjusted (to the 2000 U.S. Standard Population) incidence and incidence-based mortality rates of colorectal (CRC), pancreas, and gastric cancer, esophageal adenocarcinoma (EAC), and hepatocellular carcinoma (HCC) in 2016, 2017, 2018, 2019, and 2020. Incidence-based mortality rates combine information on cancer-specific deaths from cancer registries (numerator) with the general population at risk (denominator), allowing estimation by cancer-specific factors such as histology and tumor stage.6 For each cancer type, we estimated rate ratios and 95% confidence intervals7 to compare rates in 2017 vs. 2016, 2018 vs. 2017, 2019 vs. 2018, and 2020 vs. 2019. We also estimated rates by sex (male vs. female), age group (18–49, 50–64, and ≥65 years), race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian or Pacific Islander, and Hispanic [any race]), and tumor stage (described in detail at: https://seer.cancer.gov/seerstat/variables/seer/yr1975_2020/lrd_stage/index.html). All analyses were conducted using SEER*Stat version 8.4.1 (available at: https://seer.cancer.gov/seerstat/).
Results
Incidence rates did not change from 2016 to 2019 but subsequently decreased in 2020 (Figure 1). The largest relative declines in incidence rates were of CRC (rate ratio [RR] 0.88; 95% CI 0.87, 0.90) and HCC (RR 0.85; 95% CI 0.82, 0.88) – about a 15% decrease from 2019 to 2020. There were smaller decreases in incidence rates of EAC (RR 0.94; 95% CI 0.89, 0.99) and pancreas (RR 0.94; 95% CI 0.92, 0.97) and gastric (RR 0.93; 95% CI 0.89, 0.96) cancer (Table 1). Results were generally consistent by age, sex, race/ethnicity, and tumor stage (Supplementary Table 1), with some exceptions. For example, there was a larger decrease in incidence rates of CRC between 2019 and 2020 among Black (from 60.0 to 50.6 per 100,000) and Asian/Pacific Islander (from 41.2 to 35.5 per 100,000) compared to White (from 51.0 to 45.4 per 100,00) persons, and smaller decreases of all GI cancers among younger (age 18–49 years) persons (Table 2). There were also larger decreases in incidence rates of local stage disease between 2019 and 2020 for CRC (from 18.0 to 14.5 per 100,000) and HCC (from 3.5 to 2.8 per 100,000).
Figure 1.
Age-adjusted incidence and incidence-based mortality rates of colorectal cancer (A, B), esophageal adenocarcinoma (C, D), hepatocellular carcinoma (E, F), pancreas cancer (G, H), and gastric cancer (I, J) in 2016, 2017, 2018, 2019, and 2020, Surveillance, Epidemiology, and End Results Program
Table 1.
Age-adjusted incidence and incidence-based mortality rates of gastrointestinal cancers in 2016, 2017, 2018, 2019, and 2020, Surveillance, Epidemiology, and End Results Program
| Colorectal | Esophageal adenocarcinoma | Hepatocellular carcinoma | Pancreas | Gastric | |
|---|---|---|---|---|---|
| Age-adjusted incidence rate per 100,000 (95% confidence interval) | |||||
| 2016 | 51.4 (50.9, 51.9) | 3.1 (3.0, 3.3) | 9.2 (9.0, 9.4) | 17.3 (17.0, 17.6) | 9.3 (9.1, 9.6) |
| 2017 | 50.0 (49.5, 50.6) | 3.2 (3.1, 3.3) | 9.0 (8.8, 9.3) | 17.3 (17.0, 17.6) | 9.5 (9.2, 9.7) |
| RR vs. 2016 | 0.97 (0.96, 0.99) | 1.02 (0.96, 1.08) | 0.98 (0.95, 1.01) | 1.00 (0.97, 1.02) | 1.02 (0.98, 1.05) |
| 2018 | 49.7 (49.2, 50.2) | 3.4 (3.2, 3.5) | 8.9 (8.7, 9.1) | 17.9 (17.6, 18.2) | 9.3 (9.1, 9.5) |
| RR vs. 2017 | 0.99 (0.98, 1.01) | 1.05 (0.99, 1.11) | 0.99 (0.95, 1.02) | 1.03 (1.01, 1.06) | 0.98 (0.95, 1.01) |
| 2019 | 50.0 (49.5, 50.5) | 3.4 (3.3, 3.6) | 8.9 (8.7, 9.1) | 17.9 (17.6, 18.2) | 9.1 (8.9, 9.3) |
| RR vs. 2018 | 1.01 (0.99, 1.02) | 1.02 (0.96, 1.08) | 1.00 (0.97, 1.03) | 1.00 (0.98, 1.03) | 0.98 (0.95, 1.01) |
| 2020 | 44.2 (43.7, 44.7) | 3.2 (3.1, 3.3) | 7.6 (7.4, 7.8) | 16.9 (16.6, 17.2) | 8.4 (8.2, 8.6) |
| RR vs. 2019 | 0.88 (0.87, 0.90) | 0.94 (0.89, 0.99) | 0.85 (0.82, 0.88) | 0.94 (0.92, 0.97) | 0.93 (0.89, 0.96) |
| Age-adjusted incidence-based mortality rate per 100,000 (95% confidence interval) | |||||
| 2016 | 34.3 (33.9, 34.8) | 2.8 (2.7, 2.9) | 7.3 (7.1, 7.5) | 15.3 (15.1, 15.6) | 7.6 (7.4, 7.8) |
| 2017 | 34.5 (34.0, 34.9) | 2.7 (2.6, 2.9) | 7.5 (7.3, 7.7) | 15.4 (15.1, 15.6) | 7.3 (7.1, 7.5) |
| RR vs. 2016 | 1.00 (0.99, 1.02) | 0.98 (0.92, 1.05) | 1.03 (0.99, 1.06) | 1.00 (0.97, 1.03) | 0.97 (0.93, 1.00) |
| 2018 | 34.4 (34.0, 34.9) | 2.8 (2.7, 3.0) | 7.6 (7.4, 7.8) | 15.8 (15.5, 16.1) | 7.3 (7.1, 7.5) |
| RR vs. 2017 | 1.00 (0.98 1.02) | 1.03 (0.97, 1.10) | 1.01 (0.98, 1.05) | 1.03 (1.00, 1.06) | 0.99 (0.95, 1.03) |
| 2019 | 33.5 (33.1, 34.0) | 2.8 (2.7, 2.9) | 7.4 (7.2, 7.6) | 15.6 (15.3, 15.9) | 7.1 (6.9, 7.3) |
| RR vs. 2018 | 0.97 (0.96, 0.99) | 0.98 (0.92, 1.05) | 0.97 (0.93, 1.00) | 0.99 (0.96, 1.01) | 0.97 (0.94, 1.01) |
| 2020 | 35.5 (35.0, 35.9) | 3.0 (2.8, 3.1) | 7.2 (7.0, 7.4) | 15.6 (15.3, 15.9) | 7.2 (7.0, 7.4) |
| RR vs. 2019 | 1.06 (1.04, 1.08) | 1.06 (1.00 1.13) | 0.97 (0.94, 1.01) | 1.00 (0.98, 1.03) | 1.02 (0.98, 1.06) |
Abbreviations: RR, rate ratio
NOTE: rate ratio compare rates in 2017 vs. 2016, 2018 vs. 2017, 2019 vs. 2018, and 2020 vs. 2019; 95% confidence intervals based on the Tiwari method
Table 2.
Age-adjusted incidence rates of gastrointestinal cancers in 2016, 2017, 2018, 2019, and 2020, by cancer type, sex, age group, race and ethnicity, and tumor stage, Surveillance, Epidemiology, and End Results Program
| Age-adjusted incidence rate per 100,000 (95% confidence interval) | |||||
|---|---|---|---|---|---|
| 2016 | 2017 | 2018 | 2019 | 2020 | |
| Colorectal cancer | |||||
| Sex | |||||
| Male | 58.4 (57.6, 59.3) | 56.7 (55.8, 57.5) | 56.8 (56.0, 57.6) | 57.6 (56.8, 58.4) | 49.7 (49.0, 50.5) |
| Female | 45.3 (44.6, 46.) | 44.2 (43.5, 44.9) | 43.5 (42.8, 44.2) | 43.3 (42.7, 44.0) | 39.3 (38.7, 39.9) |
| Age | |||||
| 18–49 | 12.5 (12.1, 12.9) | 12.9 (12.6, 13.3) | 12.8 (12.4, 13.2) | 13.5 (13.1, 13.9) | 12.9 (12.5, 13.3) |
| 50–64 | 73.5 (72.2, 74.9) | 70.8 (69.5, 72.2) | 71.3 (70.0, 72.6) | 73.8 (72.4, 75.1) | 63.8 (62.5, 65.0) |
| 65+ | 168.1 (165.7, 170.5) | 161.6 (159.2, 163.9) | 159.9 (153.9, 158.2) | 156.1 (153.9, 158.2) | 135.9 (133.9, 138.0) |
| Race and ethnicity | |||||
| Hispanic (any race) | 46.3 (45.0, 47.7) | 45.3 (44.0, 46.6) | 44.6 (43.3, 45.9) | 43.7 (42.5, 44.9) | 38.9 (37.8, 40.0) |
| Non-Hispanic Asian or Pacific Islander | 44.2 (42.7, 45.7) | 42.1 (40.6, 43.5) | 40.3 (38.9, 41.8) | 41.2 (39.8, 42.6) | 35.5 (34.2, 36.8) |
| Non-Hispanic Black | 61.9 (60.0, 63.9) | 59.1 (57.3, 61.0) | 58.4 (56.6, 60.3) | 60.0 (58.2, 61.9) | 50.6 (48.9, 52.2) |
| Non-Hispanic White | 51.6 (50.9, 52.3) | 50.7 (50.0, 51.4) | 50.6 (49.9, 51.3) | 51.0 (50.3, 51.7) | 45.4 (44.8, 46.1) |
| Tumor stage | |||||
| Local | 18.4 (18.0, 18.7) | 17.4 (17.1, 17.7) | 18.3 (18.0, 18.7) | 18.0 (17.7, 18.3) | 14.5 (14.3, 14.8) |
| Regional | 18.8 (18.4, 19.1) | 18.4 (18.1, 18.7) | 16.6 (16.3, 16.9) | 17.3 (17.0, 17.6) | 16.0 (15.7, 16.3) |
| Distant | 10.8 (10.6, 11.1) | 10.6 (10.4, 10.9) | 11.0 (10.8, 11.2) | 11.2 (11.0, 11.5) | 10.5 (10.3, 10.7) |
| Esophageal adenocarcinoma | |||||
| Sex | |||||
| Male | 5.9 (5.6, 6.2) | 6.1 (5.9, 6.4) | 6.3 (6.0, 6.6) | 6.4 (6.1, 6.6) | 6.0 (5.8, 6.3) |
| Female | 0.9 (0.8, 1.0) | 0.8 (0.7, 0.9) | 0.9 (0.8, 1.0) | 0.9 (0.8, 1.0) | 0.8 (0.8, 0.9) |
| Age | |||||
| 18–49 | 0.3 (0.3, 0.4) | 0.4 (0.3, 0.5) | 0.4 (0.3, 0.5) | 0.4 (0.3, 0.5) | 0.4 (0.4, 0.5) |
| 50–64 | 4.3 (4.0, 4.7) | 4.7 (4.4, 5.0) | 4.6 (4.3, 4.9) | 4.9 (4.5, 5.2) | 4.4 (4.1, 4.7) |
| 65+ | 12.2 (11.5, 12.8) | 11.8 (11.2, 12.4) | 12.8 (12.1, 13.4) | 12.9 (12.3, 13.6) | 12.0 (11.4, 12.6) |
| Race and ethnicity | |||||
| Hispanic (any race) | 2.0 (1.7, 2.3) | 2.1 (1.9, 2.4) | 1.9 (1.6, 2.2) | 2.0 (1.7, 2.3) | 1.9 (1.6, 2.2) |
| Non-Hispanic Asian or Pacific Islander | 0.8 (0.6, 1.0) | 0.7 (0.6, 1.0) | 0.7 (0.5, 0.9) | 0.7 (0.5, 0.9) | 0.8 (0.7, 1.1) |
| Non-Hispanic Black | 1.2 (1.0, 1.5) | 0.9 (0.6, 1.1) | 1.1 (0.8, 1.3) | 1.2 (1.0, 1.5) | 1.0 (0.8, 1.3) |
| Non-Hispanic White | 4.0 (3.9, 4.2) | 4.2 (4.0, 4.4) | 4.5 (4.3, 4.7) | 4.6 (4.4, 4.8) | 4.3 (4.1, 4.4) |
| Tumor stage | |||||
| Local | 0.6 (0.6, 0.7) | 0.6 (0.6, 0.7) | 0.8 (0.7, 0.8) | 0.8 (0.8, 0.9) | 0.7 (0.6, 0.7) |
| Regional | 1.1 (1.0, 1.1) | 1.0 (0.9, 1.1) | 1.0 (0.9, 1.1) | 0.9 (0.9, 1.0) | 0.9 (0.9, 1.0) |
| Distant | 1.2 (1.1, 1.2) | 1.3 (1.2, 1.4) | 1.3 (1.2, 1.4) | 1.4 (1.3, 1.5) | 1.4 (1.3, 1.5) |
| Hepatocellular carcinoma | |||||
| Sex | |||||
| Male | 15.0 (14.6, 15.4) | 14.8 (14.4, 15.2) | 14.4 (14.0, 14.8) | 14.3 (13.9, 14.7) | 12.2 (11.8, 12.5) |
| Female | 4.2 (4.0, 4.4) | 4.0 (3.8, 4.2) | 4.1 (3.9, 4.3) | 4.2 (4.0, 4.4) | 3.6 (3.4, 3.8) |
| Age | |||||
| 18–49 | 0.8 (0.7, 0.9) | 0.8 (0.7, 0.9) | 0.7 (0.6, 0.8) | 0.7 (0.6, 0.8) | 0.7 (0.6, 0.8) |
| 50–64 | 18.5 (17.9, 19.1) | 16.8 (16.2, 17.5) | 15.9 (15.3, 16.5) | 14.9 (14.3, 15.5) | 11.9 (11.4, 12.4) |
| 65+ | 29.1 (28.2, 30.1) | 30.0 (29.0, 31.) | 30.8 (29.9, 31.8) | 32.0 (31.0, 33.0) | 27.7 (26.8, 28.6) |
| Race and ethnicity | |||||
| Hispanic (any race) | 14.0 (13.3, 14.8) | 14.4 (13.6, 15.1) | 14.0 (13.3, 14.8) | 14.1 (13.4, 14.8) | 11.7 (11.1, 12.4) |
| Non-Hispanic Asian or Pacific Islander | 13.2 (12.4, 14.0) | 12.7 (11.9, 13.5) | 12.0 (11.3, 12.8) | 11.7 (11.0, 12.5) | 9.8 (9.2, 10.5) |
| Non-Hispanic Black | 11.6 (10.8, 12.4) | 11.2 (10.5, 12.0) | 11.3 (10.5, 12.1) | 10.4 (9.7, 11.1) | 8.3 (7.7, 9.0) |
| Non-Hispanic White | 7.1 (6.8, 7.3) | 6.8 (6.5, 7.0) | 6.8 (6.6, 7.1) | 6.8 (6.6, 7.0) | 5.9 (5.7, 6.1) |
| Tumor stage | |||||
| Local | 4.8 (4.6, 5.0) | 4.7 (4.6, 4.9) | 3.3 (3.2, 3.5) | 3.5 (3.4, 3.6) | 2.8 (2.7, 2.9) |
| Regional | 2.2 (2.1, 2.3) | 2.1 (2.0, 2.2) | 3.3 (3.2, 3.4) | 3.3 (3.2, 3.5) | 2.9 (2.8, 3.0) |
| Distant | 1.3 (1.2, 1.3) | 1.2 (1.1, 1.3) | 1.3 (1.2, 1.3) | 1.2 (1.1, 1.3) | 1.1 (1.0, 1.2) |
| Pancreas cancer | |||||
| Sex | |||||
| Male | 19.6 (19.1, 20.1) | 19.6 (19.1, 20.1) | 20.4 (19.9, 20.9) | 20.3 (19.8, 20.7) | 19.0 (18.6, 19.5) |
| Female | 15.4 (15.0, 15.8) | 15.3 (14.9, 15.6) | 15.7 (15.4, 16.1) | 16.0 (15.6, 16.4) | 15.1 (14.7, 15.5) |
| Age | |||||
| 18–49 | 1.9 (1.7, 2.0) | 1.9 (1.8, 2.1) | 1.9 (1.7, 2.0) | 2.0 (1.8, 2.1) | 1.8 (1.7, 2.0) |
| 50–64 | 19.2 (18.6, 19.9) | 19.2 (18.6, 19.9) | 20.3 (19.6, 21.0) | 20.1 (19.4, 20.8) | 19.1 (18.5, 19.8) |
| 65+ | 71.9 (70.3, 73.5) | 71.5 (70.0, 73.0) | 74.1 (72.5, 75.6) | 74.2 (72.7, 75.7) | 69.8 (68.4, 71.3) |
| Race and ethnicity | |||||
| Hispanic (any race) | 16.0 (15.1, 16.8) | 15.5 (14.7, 16.4) | 16.4 (15.6, 17.3) | 16.1 (15.3, 16.9) | 14.7 (14.0, 15.5) |
| Non-Hispanic Asian or Pacific Islander | 14.0 (13.2, 14.9) | 13.7 (12.9, 14.6) | 14.3 (13.5, 15.1) | 13.9 (13.1, 14.7) | 12.9 (12.1, 13.7) |
| Non-Hispanic Black | 20.8 (19.7, 22.0) | 22.1 (20.9, 23.3) | 22.0 (20.9, 23.2) | 21.9 (20.8, 23.1) | 21.2 (20.2, 22.3) |
| Non-Hispanic White | 17.5 (17.0, 17.7) | 17.4 (17.0, 17.8) | 18.2 (17.8, 18.6) | 18.3 (18.0, 18.7) | 17.3 (17.0, 17.7) |
| Tumor stage | |||||
| Local | 2.3 (2.1, 2.4) | 2.3 (2.2, 2.4) | 2.7 (2.6, 2.8) | 2.8 (2.7, 3.0) | 2.7 (2.5, 2.8) |
| Regional | 5.0 (4.8, 5.1) | 5.0 (4.8, 5.2) | 5.0 (4.8, 5.1) | 4.9 (4.8, 5.1) | 4.5 (4.4, 4.7) |
| Distant | 8.4 (8.1, 8.6) | 8.4 (8.2, 8.6) | 8.5 (8.3, 8.8) | 8.5 (8.3, 8.7) | 8.3 (8.1, 8.5) |
| Gastric cancer | |||||
| Sex | |||||
| Male | 12.2 (11.8, 12.6) | 12.5 (12.1, 12.9) | 12.2 (11.8, 12.6) | 11.7 (11.3, 12.1) | 10.9 (10.5, 11.2) |
| Female | 7.1 (6.8, 7.3) | 7.1 (6.8, 7.3) | 7.0 (6.7, 7.2) | 7.0 (6.7, 7.3) | 6.4 (6.2, 6.7) |
| Age | |||||
| 18–49 | 2.0 (1.9, 2.2) | 2.2 (2.1, 2.4) | 2.2 (2.0, 2.3) | 2.2 (2.1, 2.4) | 2.0 (1.8, 2.1) |
| 50–64 | 11.7 (11.1, 12.2) | 11.6 (11.1, 12.1) | 11.3 (10.8, 11.8) | 11.3 (10.8, 11.8) | 10.3 (9.8, 10.8) |
| 65+ | 33.5 (32.5, 34.6) | 33.7 (32.7, 34.8) | 33.1 (32.0, 34.1) | 31.7 (30.7, 32.7) | 30.0 (29.0, 30.9) |
| Race and ethnicity | |||||
| Hispanic (any race) | 13.5 (12.7, 14.2) | 14.1 (13.3, 14.9) | 13.3 (12.6, 14.0) | 13.3 (12.7, 14.1) | 11.8 (11.1, 12.4) |
| Non-Hispanic Asian or Pacific Islander | 13.1 (12.3, 14.0) | 12.5 (11.7, 13.4) | 11.8 (11.0, 12.6) | 12.0 (11.2, 12.7) | 10.1 (9.4, 10.8) |
| Non-Hispanic Black | 12.8 (11.9, 13.7) | 13.0 (12.1, 14.0) | 13.1 (12.2, 14.0) | 12.2 (11.3, 13.0) | 12.4 (11.6, 13.3) |
| Non-Hispanic White | 7.1 (6.9, 7.4) | 7.2 (7.0, 7.5) | 7.1 (6.9, 7.4) | 6.8 (6.5, 7.0) | 6.4 (6.2, 6.6) |
| Tumor stage | |||||
| Local | 2.7 (2.5, 2.8) | 2.7 (2.6, 2.8) | 2.9 (2.7, 3.0) | 2.9 (2.8, 3.0) | 2.6 (2.5, 2.7) |
| Regional | 2.3 (2.1, 2.4) | 2.4 (2.3, 2.5) | 2.0 (1.9, 2.1) | 2.0 (1.9, 2.1) | 1.8 (1.7, 1.9) |
| Distant | 3.2 (3.1, 3.4) | 3.2 (3.1, 3.4) | 3.3 (3.2, 3.4) | 3.1 (3.0, 3.3) | 3.1 (2.9, 3.2) |
Decreasing incidence rates corresponded to fewer diagnoses during the second quarter (April – June) of 2020 compared to other quarters. For example, 19.8% of CRC diagnoses occurred in the second quarter compared to 27.5% in the third quarter (July – September), and similarly, 21.8% and 27.2% of gastric cancers were diagnosed in the second and third quarter, respectively (data not shown).
In contrast to declining incidence rates, incidence-based mortality rates of HCC (RR 0.97; 95% CI 0.94, 1.01) and pancreas (RR 1.00; 95% CI 0.98, 1.03) and gastric (RR 1.02; 95% CI 0.98, 1.06) cancer did not decrease from 2019 to 2020 (Figure 1, Table 1). Mortality rates of CRC and EAC slightly increased from 2019 to 2020 (CRC: RR 1.06; 95% CI 1.04, 1.08; EAC: RR 1.06; 95% CI 1.00, 1.13).
Discussion
We observed a clear decline in incidence rates of all GI cancers in 2020 compared to prior years. These declines corresponded to fewer diagnoses between March and June 2020, as well as lower rates of early-stage disease. Although incidence rates of some GI cancers were declining before the COVID-19 pandemic (e.g., CRC due to screening,8 HCC due to treatment of Hepatitis C9), the decrease from 2019 to 2020 – as much as 15% - is of far greater magnitude than pre-pandemic declines. Mortality rates of CRC and EAC increased during the same period. It is still early to understand the full impact of the pandemic on cancer-related care, but the fewer diagnoses in 2020 may result in a “catch up” period of increasing incidence and mortality rates in the future.
Declining incidence rates and fewer diagnoses of GI cancers in mid-2020 are likely related to missed cancer cases rather than a true decrease in cancer burden. Our findings are consistent with a recent study from the National Cancer Database that reported a substantial decrease in all cancer diagnoses in 2020 compared to prior years, with the largest decrease in early-stage diagnoses.10 Some reports indicate near-complete recovery of screening and diagnostic testing to pre-pandemic levels, while others indicate a continued backlog in these services.2, 11 It will be critical to monitor incidence and mortality rates over the next several years to determine whether pandemic-related delays in 2020 and consequent backlogs will result in increasing incidence and mortality rates.
In addition, we observed that older adults and racial and ethnic minorities experienced larger declines in incidence rates of many GI cancers. Previous studies have demonstrated age- and race-related disparities in COVID-19 outcomes,12 with poorer outcomes among persons with cancer, particularly among Black persons with cancer.13 As healthcare systems develop strategies to mitigate the impact of the pandemic, it will be important to address the resulting disparities and prioritize efforts to ensure equitable access to care.
In summary, our findings reveal a decrease in incidence rates of GI cancers in 2020, and this decrease may lead to “catch up” period of increasing incidence and mortality rates in the future. Results underscore the importance of identifying persons in need of screening or diagnostic tests; prioritizing higher-risk groups; and avoiding overutilization in lower-risk groups.
Supplementary Material
Grant support:
This work was supported by the National Cancer Institute at the National Institutes of Health under award numbers R01CA242558 (CC Murphy), U01CA271887 (AG Singal), U01CA230694 (AG Singal), R01CA256977 (AG Singal), U01DK129191 (S Wani), and U01CA271867 (S Wani) and the Katy O. and Paul M. Rady Endowed Chair in Esophageal Cancer Research (S Wani). The sponsor had no role in: design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Footnotes
Disclosures: AGS reports consulting and participating in advisory boards for Genentech, AstraZeneca, Eisai, Bayer, Exelixis, Boston Scientific, FujiFilm Medical Sciences, Exact Sciences, Roche, Glycotest, Freenome, and GRAIL. CCM reports consulting for Freenome. SW reports consulting for Exact Sciences, Castle Biosciences and Research Support: Lucid, Ambu, and CDx Diagnostics; all other authors have no conflicts to disclose.
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