To the Editors:
We read with interest the article by Challine et al (2021)1 comparing the number of colonoscopies during the coronavirus disease 2019 (COVID-19) lockdown and postlockdown periods in France with those from the previous 2 years. The comparison clearly highlighted the decrease in colorectal cancer (CRC) screenings during the lockdown, without any compensatory postlockdown increase, predicting a rise in undiagnosed colorectal cancers. Data were collected from a national database with mandatory reporting from both public and private hospitals, allowing for a comprehensive analysis of health data in France. However, the article did not categorize the number of colonoscopies by race/ethnicity or socioeconomic status, which would allow for a detailed comparison with findings from other countries.
In the United States, African Americans, Native Americans, and other underprivileged minorities, often with less access to quality healthcare, preemptive screenings, and a healthy diet, suffer from lower survival for all stages of CRC.2 Cancer screening is likely to play a major role in this disparity since, from 1975 to 2015, the incidence of CRC in the United States decreased by 21% among African Americans (from 56.9 to 44.7 per 100,000), compared to a 40% decrease in Whites (60.2 to 36.2).2 , 3
Additionally, the association between social measures (socioeconomic status, race/ethnicity) and CRC mortality was examined comparing behavioral and medical preventive factors over time with population-based CRC mortality trend data in the United States.4 A lower socioeconomic status, as well as race/ethnicities of African American, Hispanic, Asian/Pacific Islander, and Native American, were found to be associated with decreased access to age-appropriate CRC screening.4
The decrease in colonoscopies described by Challine et al during the current COVID-19 pandemic foreshadows a rise in CRC mortality. Future studies of delay in screening practices should collect data on ethnic/racial minorities and low socioeconomic status groups to identify disparities and provide the information needed to equitably address this important public health challenge through targeted interventions.
Funding/Support
VPM is funded by US National Institutes of Health grant R25 CA244073.
Conflict of interest/Disclosure
The authors have no disclosure.
References
- 1.Challine A., Lazzati A., Dousset B., Voron T., Parc Y., Lefevre J.H. Colorectal screening: we have not caught up. A surge of colorectal cancer after the coronavirus disease 2019 (COVID-19) pandemic? Surgery. 2021 doi: 10.1016/j.surg.2021.03.021. S0039-6060(20)30856-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rawla P., Sunkara T., Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14:89–103. doi: 10.5114/pg.2018.81072. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.SEER∗Explorer: An interactive website for SEER cancer statistics [Internet]. Surveillance Research Program. National Cancer Institute; 2017. [Google Scholar]
- 4.Clouston S.A.P., Acker J., Rubin M.S., Chae D.H., Link B.G. Fundamental social causes of inequalities in colorectal cancer mortality: a study of behavioral and medical mechanisms. Heliyon. 2020;6 doi: 10.1016/j.heliyon.2020.e03484. [DOI] [PMC free article] [PubMed] [Google Scholar]