Did the COVID-19 pandemic exacerbate existing racial discrepancies in the diagnosis of different cancers?

By Dr. Chinta SidharthanNov 24 2022Reviewed by Aimee Molineux

In a recent study published in Cancer Medicine, researchers investigated whether disparities in the presentation of late-stage prostate, lung, colorectal, and breast cancers associated with race were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic.

Background

A substantial number of studies indicate that cancer-related morbidity and mortality vary according to race. Factors such as socioeconomic disadvantages, absent or incomplete insurance coverage, access to health care facilities, imbalances in patient-provider dynamics, and social biases seem to be responsible for Black persons having higher morbidity and mortality rates, especially in the case of breast, prostate, lung, and colorectal cancers.

Delayed diagnoses also lead to worse prognoses and a higher risk of cancer-related mortality. The incidence of cancers in the advanced stages, especially the four major types, is higher among Black patients than White patients.

The shift in healthcare facilities worldwide to deal with the COVID-19 pandemic and the social restrictions enforced to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in disruptions and delays in cancer screening and care and a subsequent increase in late-stage cancers and death. However, the effect of the COVID-19 pandemic on existing racial disparities in cancer diagnoses and treatments remains unexplored.

About the study

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

The data obtained from the registries consisted of the type of cancer (breast, lung, colorectal, or prostate), diagnosis date, patient’s race, age during diagnosis, sex, cancer stage, and insurance status (uninsured or insured with Medicaid, Medicare, private or other insurance). The tumor, node, and metastasis classification from the American Joint Committee on Cancer was used to define the cancer stage.

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

Results

The results indicated that while Black patients continued to have a higher probability of metastatic cancer diagnoses than White patients, the COVID-19 pandemic did not exacerbate the racial disparities in late-stage cancer detections. The pandemic resulted in an overall reduction in diagnoses of all four types of cancers due to the abrupt discontinuation 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, which dropped to 1184 during the early-COVID-19 period. Furthermore, new metastatic cancer diagnoses increased by 21.4% in the early COVID-19 period.

According to the authors, the absence of racial disparities in early COVID-19 metastatic cancer diagnoses could be due to many COVID-19-related mortalities among Black patients who were seen to be more susceptible to SARS-CoV-2, especially patients who might have had undiagnosed metastatic cancers.

Additionally, the proportional reduction due to the COVID-19 pandemic in the diagnoses of all four types of cancer was consistent with results from other studies that showed similar patterns for breast, colorectal, esophageal, gastric, and pancreatic cancers.

The short duration of the study did not allow the researchers to draw inferences on the long-term outcomes of COVID-19 on cancer diagnoses. Furthermore, other studies have shown that people of Hispanic origin have similarly increased morbidity and mortality rates as Black patients, compared to White patients. Therefore, excluding Hispanic patients from the analyses is one of the limitations of this study.

Conclusions

Overall, the results reported that while Black patients continued to have higher incidences of metastatic cancer diagnoses than White patients, the COVID-19 pandemic did not intensify the racial discrepancies.

However, additional research with longer study periods and the inclusion of other racial groups in the analyses are required for a comprehensive understanding of the impact of the COVID-19 pandemic on cancer diagnoses and treatment.