Temporal and geographic analyses of colorectal cancer screening during and after the COVID-19 pandemic in a federally qualified health center.

Abstract

The COVID-19 pandemic caused reductions in cancer screening services. We assessed the pandemic's impact on colorectal cancer screening in a large diverse federally qualified health center (FQHC) in Los Angeles, CA. We used interrupted time series regression to estimate trends in monthly colorectal cancer screening rates for four relevant COVID-19 pandemic periods: pre-pandemic (March 2018 - February 2020); early-pandemic (March - December 2020); vaccine-era (January 2021- May 2023); and post-pandemic (June 2023 - May 2024). We plotted spatial distribution patterns of screening across census tracts. Participants were 83,430 unique individuals (55% male; 80% Hispanic) ages 50-75. Average monthly colorectal cancer screening rates dropped from 9.3% pre-pandemic to 5.9% early-pandemic. Monthly screening rates in the vaccine era (7.5%) never returned to pre-pandemic levels and further declined in the post-pandemic era (6.7%; p trend = 0.09). Screening rates were consistently higher for males, ages 65-75, Hispanic individuals, and Spanish-preferring individuals in both pre-COVID (March 2018-Feb 2020) and post-COVID (July 2020-May 2024) periods. Increases in stool-based testing aligned with mailed outreach campaigns. Monthly post-pandemic screening rates never reached pre-pandemic levels and declined from 2023 to 2024. Sharp increases in stool-based testing coincided with mailed outreach events, highlighting the importance of home-based screening methods during disruptive events. Our findings can help shape healthcare response strategies to reduce screening delays in the context of future natural disasters.