ASPO Abstracts
Trends in cancer screening in a Federally Qualified Health Center before and after the onset of the COVID-19 pandemic
Category: COVID-19 and Cancer
Conference Year: 2021
Abstract Body:
Purpose: The COVID-19 pandemic has forced health care systems to rapidly transform care
delivery, resulting in delays in non-critical care. To date, data emerging from health systems has
primarily captured changes in cancer screening volume without calculating screening rates, a
more important metric for population health. The purpose of this study was to assess the impact
of the pandemic on up-to-date cancer screening rates in a large Federally Qualified Health
Center (FQHC) serving a primarily Latino population.
Methods: We evaluated electronic health record data between October 2019 and October 2020
in a large FQHC in Los Angeles County. Monthly up-to-date breast (mammogram in past 2
years), cervical (Pap test in past 3 years), and colorectal cancer (CRC) rates (fecal
immunochemical test in past year, colonoscopy in past 10 years) were calculated among age-
eligible patients, including approximately 7500 patients for breast, 20,000 for cervical, and
12,000 for CRC screening.
Results: In the period preceding the onset of COVID-19 (Oct 2019-March 2020), monthly rates
of up-to-date breast cancer screening among women ages 50-74 years hovered around 70%.
Average monthly rates in the post-COVID period (April-Oct 2020) declined slightly with the
lowest rate, 68%, observed in October 2020. Monthly cervical cancer screening rates among
eligible women ages 24-64 years remained steady across the observation period, ranging from
72-73%. Up-to-date CRC screening rates fluctuated between 56-58% among patients ages 50-
74 years pre-COVID-19, but steadily declined post-COVID to 47% in October 2020.
Conclusion: We observed minimal changes in up-to-date rates of breast and cervical cancer
screening in the 8 months following the onset of the pandemic, but a substantial decline in CRC
screening. The greater reduction in CRC screening rates (vs. breast and cervical) may be due
to the recommended annual interval for stool-based testing, the predominant CRC screening
modality in safety net settings. The ongoing pandemic's impact on breast and cervical cancer
screening rates over time remains unclear as more women become eligible for their next
recommended test. FQHCs are an important research setting given disproportionate impacts of
COVID-19 on populations they serve.
Keywords: cancer screening, COVID-19, federally qualified health center