1. Nolen, Lindsey

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As a result of suspended clinic operations and patient caution during the onset of the coronavirus pandemic, cancer screening has decreased over the past year. This includes low-dose CT scanning for lung nodules, which is a benefit for people over age 50 who have a significant risk of tobacco.

Lung Cancer Screenin... - Click to enlarge in new windowLung Cancer Screening. Lung Cancer Screening

According to Norman Sharpless, MD, Director of the National Cancer Institute, the decrease in low-dose CT scanning for lung nodules and subsequent increased number of suspicious pulmonary nodules have become particularly alarming. Recently, research published by the Southern Surgical Association, titled "Impact of the COVID-19 Pandemic on Lung Cancer Screening Program and Subsequent Lung Cancer," exemplified these findings (J Am Coll Surg 2021;


The researchers began their study after the university resumed operations and clinicians noticed an increase in the number of suspicious pulmonary nodules, which caused concern. Based on this observation, they developed their study to ultimately examine the impact of COVID-19 on lung cancer screening at the center.


"While at tumor board during the reopening, [lead author Robert M. Van Haren, MD, MSPH, FACS] noticed that many more patients were being referred for intervention than was usual, but significantly less patients were showing up to their appointments," noted Aaron M. Delman, MD, study co-author and a general surgery resident at the University of Cincinnati. "He knew the benefit that screening provides in decreasing lung cancer mortality and wanted to make sure patients knew that they should continue to attend their screening appointments."


Study Details

During their independent analysis, researchers studied data from the lung screening program at the University of Cincinnati and analyzed the institution's prospective low-dose computed tomography (LDCT) screening database. In all, 2,153 patients had participated since the inception in 2012. Using this information, a team of multidisciplinary clinicians and staff members compared the monthly mean number of LDCTs between the baseline (January 2017 to February 2020) and COVID-19 periods (March 2020 to July 2020).


By the study's conclusion, the researchers affirmed that COVID-19 has caused significant disruption in lung cancer screening, leading to a decrease in new patients screened and an increased proportion of nodules suspicious for malignancy once screening resumed. More specifically, 818 screenings were canceled when LDCT was suspended March 13, 2020. Since the phased reopening began May 5 and a full reopening June 1, the total monthly mean SD LDCTs (146 +/- 31 vs. 39 +/- 40; p < 0.01) and new patient monthly LDCTs (56 +/- 14 vs 15 +/- 17; p < 0.01) were significantly decreased.


"We found in our study that, while the rate of LDCT screening has increased over time (the last 7 years at our institution), this year [2020], we saw a sharp decline due to COVID-19. We had our screening completely fall off," Delman recalled. "Not only due to shutdowns of the screening program for 2 months in March, but when we reopened the screening program we still had significantly less patients making it to their previously scheduled appointments. We knew the screenings would decrease for when we were shut down, but we thought upon reopening, activities would return more towards baseline."


"This is what we expected to see," noted Van Haren, Assistant Professor and Thoracic Surgeon at the University of Cincinnati College of Medicine. "However, we were surprised by our findings of what happened when we resumed LDCT screenings. When we resumed operations, we found [the] increased number of suspicious pulmonary nodules. We also found that patients were more likely not to show up for their CT appointments, and the rate of new patients receiving screenings was decreased."


Continued Screening Needed

Within the research, authors noted that, by using lung cancer and the LDCT screening program as a model, their findings can serve as an early analysis of the unrecognized consequences of the pandemic relating to screening programs and cancer care. Van Haren explained that the results demonstrate the negative consequences COVID-19 has on the oncology community, and that it is critical to continue cancer screening operations, such as lung cancer screening, during this pandemic.


"This is important because as we are learning, the pandemic is ongoing," Van Haren stressed.


"We think this [information] is important for all cancers that have successful screening programs, especially lung, colon and breast, where routine screening has been shown to save lives," Delman added. "This reminds providers how important it is for us to continue to provide screening opportunities for patients and encourage our patients not to miss their screening opportunities."


He continued by sharing that the research team believes this information provides patients and clinicians with the importance of screening, even in uncommon settings. Given the length of the pandemic, Delman thinks the study stressed the importance of reopening screening programs and encouraging patients to attend the screenings.


"This phenomenon is likely not unique to lung cancer and lung cancer screening," Delman said. "The patient population who benefits from screening should continue to get screened to avoid increased risk of lung cancer mortality."


Lindsey Nolen is a contributing writer.