Impairment of colorectal cancer screening during the COVID-19 pandemic
Authors: Serhiy Semenov, Mohd Syafiq Ismail, Deirdre McNamara
Journal: The Lancet. Gastroenterology & hepatology (2021)

We read with great interest the Article by Lucie de Jonge and colleagues.1de Jonge L Worthington J van Wifferen F et al.Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study.Lancet Gastroenterol Hepatol. 2021; 6: 304-314Summary Full Text Full Text PDF PubMed Scopus (85) Google Scholar The authors acknowledge a substantial concern regarding colorectal cancer screening: the short-term and long-term negative effects of disruptions in screening due to the COVID-19 pandemic. By applying microsimulation models to three countries with established screening programmes—Australia, Canada, and the Netherlands—the authors predict a worrying increase in colorectal cancer incidence (0·4–1·2%) and related deaths (0·8–2·0%) within 30 years, assuming a 12-month screening disruption. They conclude that providing immediate catch-up screening can restrict colorectal cancer incidence and deaths (2020–50) to less than 0·1% in all three countries. Considering that catch-up screening could temporarily increase colonoscopy demand to nearly twice that of normal levels,1de Jonge L Worthington J van Wifferen F et al.Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study.Lancet Gastroenterol Hepatol. 2021; 6: 304-314Summary Full Text Full Text PDF PubMed Scopus (85) Google Scholar we feel this solution might not be feasible in some health-care systems. Highlighting alternative solutions is imperative for a colonoscopy service that is already under strain. In a 2020 guideline update by Spada and colleagues,2Spada C Hassan C Bellini D et al.Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline—update 2020.Eur Radiol. 2020; 52: 1127-1141Google Scholar CT colonography (CTC) is recommended when faecal immunohistochemical test (FIT)-based screening is unavailable, because of reported higher participation and acceptability with CTC versus colonoscopy, and a similar frequency of adverse events (0·2% vs 0·3%). Furthermore, Vuik and colleagues3Vuik FER Nieuwenburg SAV Moen S et al.Colon capsule endoscopy in colorectal cancer screening: a systematic review.Endoscopy. 2021; (published online Jan 13.)https://doi.org/10.1055/a-1308-1297PubMed Google Scholar reported in their systematic review that colon capsule endoscopy (CCE), compared with CTC, had a higher polyp detection rate (60·0–100·0% vs 28·6–81·0%) and sensitivity (84·0–97·3% vs 32·0–90·0%), with similar specificity (87·8–97·0% vs 84·8–99·0%). Our local Irish data, published by the Trinity Academic Gastroenterology Group research centre at Tallaght University Hospital (Dublin, Ireland) confirms that CCE is effective at detecting neoplastic polyps in a FIT-positive screening cohort and would reduce the number of colonoscopies by 71%.4Holleran G Leen R O'Morain C McNamara D Colon capsule endoscopy as possible filter test for colonoscopy selection in a screening population with positive fecal immunology.Endoscopy. 2014; 46: 473-478Crossref PubMed Scopus (61) Google Scholar In Ireland, colorectal cancer screening is only done in units certified by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG), by endoscopists accredited by the National Cancer Screening Service. Owing to excess waiting lists in most Irish endoscopy units, a minority are JAG-certified. The training time to become an accredited endoscopist is around 5–8 years. Applicants are required to meet quality indicators for colonoscopies and to have done more than 300 colonoscopies within a year. By contrast, much less time is required to train competent screening CCE readers. In an unpublished survey at our CCE centre at Tallaght University Hospital, we found that CCE readers can achieve competence at 30–50 procedures, and similar reading times to colonoscopy (30–45 min). Artificial intelligence in capsule endoscopy5Chetcuti Zammit S Sidhu R Capsule endoscopy—recent developments and future directions.Expert Rev Gastroenterol Hepatol. 2021; 15: 127-137Crossref PubMed Scopus (38) Google Scholar will improve CCE training and further shorten reading time, allowing CCE to be used as a viable alternative in catch-up colorectal cancer screening. To conclude, colorectal cancer screening has required new solutions in the current climate and alternative modalities should be a serious consideration. We declare no competing interests. SS and MSI contributed equally to this Correspondence. Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling studyAlthough the projected effect of short-term disruption to colorectal cancer screening is modest, such disruption will have a marked impact on colorectal cancer incidence and deaths between 2020 and 2050 attributable to missed screening. Thus, it is crucial that, if disrupted, screening programmes ensure participation rates return to previously observed rates and provide catch-up screening wherever possible, since this could mitigate the impact on colorectal cancer deaths. Full-Text PDF Impairment of colorectal cancer screening during the COVID-19 pandemicWe welcome the Article by Lucie de Jonge and colleagues,1 as it conveys important information on the effects of the COVID-19 pandemic on programmatic colorectal cancer screening, and underlines the notion that health-care systems must react to these unexpected disruptions with meaningful ad-hoc strategies. de Jonge and colleagues' comparative modelling study assessed the short-term (2020–24) and long-term (up to 2050) effects of the pandemic by use of four microsimulation models for screening programmes in Australia, Canada, and the Netherlands. Full-Text PDF