New data reveal COVID’s impact on cancer screening

Alongside well-documented disruptions to healthcare services, the COVID-19 pandemic brought with it a marked drop in participation of all three of Australia’s national cancer screening programs, leading to delays in diagnoses.
 
These reports have now been given further context, following the release of Australian Institute of Health and Welfare (AIHW) data on participation and activity rates for Australia’s three national Cancer screen programs.
 
BreastScreen Australia
Having hovered around a 55% participation rate since the program was instituted in 2014–15, participation among eligible women (those aged 50–74) fell to 49% in 2019–20, constituting a 9% drop.
 
During this period, almost 1.8 million eligible women participated in the BreastScreen program, with activity severely hampered in April 2020 following a ‘temporary pause’ due to the COVID-19 pandemic.
 
Only 1116 screening visits were conducted that month, compared to more than 70,000 in March and 75,000 the previous April. A separate AIHW report on the impact of COVID-19 on cancer screening also revealed that almost 73,000 fewer mammograms were performed in April 2020 compared to 2018.
 
However, while screening numbers were also compromised in May 2020 (38,000 screening visits), the program has since shown signs of recovery, with subsequent months similar to previous years.

Overall, 137,000 fewer mammograms were performed in 2020 compared to 2019.
 
Cervical screening
A similar narrative exists for cervical screening.
 
April 2020 saw national screening rates drop by 67%, while in May, presentations were still down by 49% compared to pre-COVID data.
 
AIHW activity data for the National Cervical Screening Program (NCSP), which covers up to December 2021, shows the number of screening test performed in 2020–21 has dropped markedly compared to previous years.
 
But crucially, the AIHW indicates this is to be expected, regardless of the pandemic and subsequent restrictions due to the program changing from two-yearly Pap tests to five-yearly cervical screening tests from December 2017.
 
In 2018–20, 3.8 million people had a cervical screening test – an estimated participation rate of 56%. The AIHW says participation in the new five-year program will be accurately reported once there are five years of data available (2018–22).
 
In the most recent two-year period, people aged 45–49 had the highest estimated participation rate (61%), while those in the 70–74 age group had the lowest estimated participation rate (27%). Lower participation rates are expected among people aged 70–74 as they have re-entered the target age group under the renewed NCSP, having left the previous program after age 69.
 
Bowel cancer screening
The impact of the pandemic on the National Bowel Cancer Screening Program (NBCSP) is somewhat difficult to gauge, with participation data only available up until the 2018–19 period.
 
However, activity data nonetheless suggests COVID-19 did have an impact on the rate of eligible people who took part in screening.
 
Having steadily increased from 512,000 returned kits in 2014 to 1.375 million in 2019, only 1.288 million kits were returned in 2020. Those figures rebounded somewhat in 2021, with 1.305 million kits returned.
 
Prior to COVID-19,  the national participation rate had increased from 38.9% of invited people in 2014–15 to 43.5% in 2018–19.
 
The AIHW also notes that since 2018, the NBCSP has broadened target ages, resulting in a steady increase in the number of invitees over time.
 
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