Invited CommentaryColorectal screening: We have not caught up. A surge of colorectal cancer after the coronavirus disease 2019 (COVID-19) pandemic?
Introduction
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), reorganized digestive care. On March 12, 2020, the French government declared national restrictions on elective surgery and gastrointestinal endoscopy for 2 months. After suspension of elective surgery, the French government reimposed restrictions on October 30, 2020. Several guidelines were rapidly published to help guide surgeons and gastroenterologists in their decision making.1, 2, 3, 4
A decrease in colorectal cancer screening was reported by Rutter et al,5 among others. In their analysis of a UK nationwide database, they found a decrease up to 95% for activity in endoscopy volumes during their lockdown. Similarly, Latinga et al reported a 44% decrease in endoscopy activity after the onset of COVID-19 for colorectal cancer screening in the Netherlands.6
However, there are no data reporting the resumption of activities in the months after the COVID-19 lockdown period. Therefore, the aim of this report was to analyze the activity after the lockdown period in the management of colorectal cancer in 2020 and its potentially significant impact on public health.
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Methods
To analyze nationwide activity, we collected data from a mandatory national database that records patient hospital stays in both public and private hospitals. Access to the database was requested from and granted by the National Commission on Informatics and Liberty. Because the identifier is anonymous, patient consent was not required.
All cases of colonoscopy or colorectal cancer resection performed from January 2020 to October 2020 were extracted from the database and compared with cases from
Results
During the prelockdown period, colonoscopy and colorectal resections were comparable among the 3 years (Fig 1). We observed a major change in the cumulative curves of colonoscopies performed between March 2020 and May 2020, corresponding to the national lockdown. As of October first, the gap in the number of colonoscopies performed in 2020 compared with 2019 was 176,107, corresponding to a decrease of 26%. During the middle of the lockdown (Apr 2020), activity decreased by 85%. A 34% decrease
Discussion
In this analysis, we reported a major gap in the number of colonoscopies performed by October 2020, corresponding to a 20% decrease (176,000) compared to the overall activity in 2019. The decreased activity has been reported in several studies.5, 6, 7 Our results are consistent with results of other recent studies.8 The novelty of our current report is the analysis of the post-COVID lockdown activity, which raises a public health concern. The rate of colonoscopies performed had reverted to
Funding/Support
No funding to report.
Conflict of interest/Disclosure
No disclosure to report.
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