Has the COVID-19 pandemic exacerbated existing racial disparities in the diagnosis of different types of cancer?

In a recently published study in cancer medicineThe researchers examined whether differences in the presentation of late-stage prostate, lung, colon and breast cancers associated with race were exacerbated during the 2019 coronavirus disease (COVID-19) pandemic.

background

A significant number of studies indicate that cancer-related morbidity and mortality varies by race. Factors such as socioeconomic disadvantage, lack of or incomplete insurance coverage, access to healthcare facilities, imbalances in patient-provider dynamics, and social prejudice appear to be responsible for Black people having higher morbidity and mortality rates, particularly in the case of breast, prostate, and lung – and colon cancer.

Delayed diagnosis also leads to poorer prognosis and a higher risk of cancer-related mortality. The incidence of advanced cancer, particularly of 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 enforced to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have resulted in disruptions and delays in cancer screening and -care and consequent increase in late-stage cancers and deaths. However, the impact of the COVID-19 pandemic on existing racial disparities in cancer diagnosis and treatment remains unexplored.

About the study

In the present study, researchers used data from cancer and tumor registries at 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, lung, prostate, and colorectal cancer 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 in the early COVID-19 period. All newly diagnosed cases of breast, lung, colon and prostate cancer in adults during these periods were included in the study.

Data obtained from the registries included the type of cancer (breast, lung, colon, or prostate), date of diagnosis, patient’s ethnicity, age at diagnosis, sex, cancer stage, and insurance status (uninsured or insured with Medicaid, Medicare, private or other insurance). The tumor, nodule, and metastasis classification of the American Joint Committee on Cancer was used to define cancer stage.

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

Results

The results showed that while black patients continued to have a higher likelihood of metastatic cancer diagnoses than white patients, the COVID-19 pandemic did not exacerbate racial disparities in late-stage cancer detection. The pandemic led to an overall drop in diagnoses of all four cancers due to the abrupt cessation of 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 cancer cases in the pre-COVID-19 period was 2120, while it decreased to 1184 in the early period of COVID-19. In addition, new metastatic cancer diagnoses increased by 21.4% in the early COVID-19 period.

According to the authors, the lack of racial disparity in early COVID-19 metastatic cancer diagnoses could be due to many COVID-19-related deaths in black patients who were thought to be more susceptible to SARS-CoV-2, especially in patients who might be undiagnosed had metastatic cancer.

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

The short duration of the study did not allow the researchers to draw any conclusions about the long-term effects of COVID-19 on cancer diagnoses. Additionally, other studies have shown that people of Hispanic descent have similar increased morbidity and mortality rates as 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 showed that while black patients continued to have higher rates of metastatic cancer diagnoses than white patients, the COVID-19 pandemic did not exacerbate racial disparities.

However, a full understanding of the impact of the COVID-19 pandemic on cancer diagnosis and treatment requires additional research with longer study periods and inclusion of other racial groups in the analyses.