Has the COVID-19 pandemic exacerbated existing racial disparities in the diagnosis of various cancers?

In a recent study published in Cancer medicineresearchers examined whether differences in the presentation of prostate, lung, colorectal, and late-stage breast cancers associated with race were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic.

Study: impact of the COVID-19 pandemic on the stage of breast, colon, lung and prostate cancer when diagnosed by race. Image credit: RAJ CREATIONZS/Shutterstock

Background

A significant number of studies indicate that cancer-related morbidity and mortality differ by race. Factors such as socioeconomic disadvantages, absent or incomplete insurance coverage, access to health care facilities, imbalances in patient-care provider dynamics, and social bias seem to be responsible for black individuals having higher rates of morbidity and mortality, especially in the case of breast, prostate cancer. , lung and colon cancer.

Delayed diagnoses also lead to poorer prognosis and a higher risk of cancer-related death. The incidence of advanced stage cancer, especially the four main types, is higher in black patients than in white patients.

The shift in healthcare facilities worldwide to deal with the COVID-19 pandemic and the social restrictions imposed to contain the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to disruptions and delays in cancer screening and care and a subsequent increase in late-stage cancer and death. However, the effect of the COVID-19 pandemic on existing racial disparities in cancer diagnoses and treatments remains unexplored.

About the study

In the current study, the researchers used data from cancer and tumor registries from Barnes Jewish Hospital, the University of Miami Health Center Sylvester Cancer Center and the Mayo Clinic to conduct a retrospective analysis of newly reported diagnoses and stages of breast cancer. , lung, prostate and colon cancer according to before and during the COVID-19 pandemic.

Cancer cases diagnosed between March and June 2019 were considered pre-COVID-19, while those diagnosed between March and June 2020 were categorized as being in the early COVID-19 period. All newly diagnosed cases of breast, lung, colorectal and prostate cancer in adults during these periods were included in the study.

The data obtained from the registries consisted of the type of cancer (breast, lung, colorectal or prostate cancer), date of diagnosis, race of patient, age at diagnosis, sex, cancer stage and insurance status (uninsured or insured with Medicaid, Medicare, private or other insurance). The tumor, node, and metastasis classification of the American Joint Committee on Cancer was used to define cancer stage.

The number of metastasis diagnoses was analyzed by race, cancer type and insurance status for the pre- and early COVID-19 periods. Logistic regression was used to compare the odds ratio of metastatic cancer diagnoses in pre- and early COVID-19 periods.

Results

The results indicated that while black patients continued to be more likely to have metastatic cancer diagnoses than white patients, the COVID-19 pandemic did not exacerbate racial disparities in late-stage cancer detection. The pandemic resulted in a general reduction in diagnoses of all four cancers due to the abrupt halt to cancer screening due to enforced lockdowns.

The total number of newly diagnosed cases during the study period was 3528, of which 83% were white patients and only 12.6% were black patients. The number of newly diagnosed cancers in the pre-COVID-19 period was 2120, which dropped to 1184 during the early COVID-19 period. In addition, new metastatic cancer diagnoses increased by 21.4% in the early COVID-19 period.

According to the authors, the absence of racial differences in early COVID-19 diagnoses of metastatic cancer could be due to many COVID-19-related deaths among black patients found to be more susceptible to SARS-CoV-2, especially patients who may be have had undiagnosed metastatic cancers.

In addition, the proportional reduction due to the COVID-19 pandemic in the diagnoses of all four cancers was consistent with the results of other studies showing similar patterns for breast, colorectal, esophageal, gastric and pancreatic cancers.

The short duration of the study prevented the researchers from drawing conclusions about the long-term outcomes of COVID-19 on cancer diagnosis. In addition, other studies have shown that people of Hispanic descent have similar increased morbidity and mortality to black patients, compared to white patients. Therefore, the exclusion of Hispanic patients from the analyzes is one of the limitations of this study.

Conclusions

Overall, the results reported that while black patients continued to have a higher incidence of metastatic cancer diagnoses than white patients, the COVID-19 pandemic did not exacerbate racial disparities.

However, additional research with longer study periods and the inclusion of other racial groups in the analyzes is needed for a comprehensive understanding of the impact of the COVID-19 pandemic on cancer diagnosis and treatment.

Magazine reference:

  • Berrian, J., Liu, Y., Ezenwajiaku, N., Moreno-Aspitia, A., Holton, S.J., Toriola, A.T., Colditz, GA, Housten, A.J., Hall, L., Fiala, MA, & Ademuyiwa, F.O. (2022). Impact of the COVID-19 pandemic on the stage of breast, colorectal, lung and prostate cancer by diagnosis by race. Cancer medicine. doi: https://doi.org/10.1002/cam4.5439 https://onlinelibrary.wiley.com/doi/10.1002/cam4.5439

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