Abstract C129: Adapting to disruption?: Changes in colorectal cancer screening modalities and disparities during the COVID-19 pandemic
Authors: Kaplan Cameron M. , Pastard Willow , Thacker John , Schneberk Todd , Lam Chun Nok , Axeen Sarah , Tsui Jennifer 
Published: September 2024

Research Objective: At-home colorectal cancer screening methods, such as Fecal Immunochemical Tests (FIT), offered a safer, convenient alternative to in-clinic procedures like colonoscopies during the COVID-19 pandemic. Racial and ethnic minorities were more likely to use these tests prior to the pandemic, but it is unclear whether disparities in colorectal cancer screening changed because of the pandemic. We examined rates of colorectal cancer screening before and after shutdown periods across race/ethnicity, age, and income among health plan enrollees in the United States to inform screening catch-up strategies after COVID-19 disruptions. Study Design: We conducted a retrospective analysis of cancer screening claims from Optum Clinformatics Data Mart among enrollees from 2019-2021. Monthly screening volume was calculated for a three-year period, with January 2019-February 2020 as the pre-pandemic period, and July 2020-December 2021 as the post-pandemic period. We conducted an event study to calculate group-level monthly predicted probabilities of screening using a linear probability model with group interactions by month, controlling for demographic variables and comorbidities. Additionally, we used difference-in-difference (DD) regressions including group interacted with a post-pandemic dummy. The pandemic closure period months were excluded from our DD analysis. Eligible enrollees included those ages 40-75 with continuous enrollment 12 months prior to screening index month. Colorectal cancer screening claims included codes for colonoscopies and other endoscopic procedures as well as FIT and FOBT tests. Results: 2,576,760 health plan enrollees were included. Colonoscopy rates did not change significantly between the pre-COVID period and post-COVID period, however FIT test screening rates dropped from an average of 0.66% of age-eligible enrollees screened per month in the pre-pandemic period to 0.58%. Our difference-in-difference results suggested Hispanic-NH White disparities in FIT tests widened. For colonoscopy, Hispanic-NH White and Asian-White disparities widened, while Black-White disparities decreased. Conclusions: Despite the promise that in-home FIT testing would substitute for colonoscopy during the pandemic, we saw a much larger decline in FIT testing rates during the pandemic than for colonoscopy and increasing disparities. This study highlights the need for targeted strategies to address screening disparities exacerbated by the COVID-19 pandemic, particularly among Hispanic and NH-Asian populations.

Citation Format: Cameron M. Kaplan, Willow Pastard, John Thacker, Todd Schneberk, Chun Nok Lam, Sarah Axeen, Jennifer Tsui. Adapting to disruption?: Changes in colorectal cancer screening modalities and disparities during the COVID-19 pandemic [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C129.