Western University, Windsor, ON, Canada
Joshua Ling, Justin Kang, Daniel Read, Vivek Singh Parmar, Fawad Ahmed, Caroline M. Hamm
Background: In Canada, colorectal cancer (CRC) ranks as the third most prevalent cancer and second leading cause of cancer mortality (1). The potential to prevent a significant proportion of colorectal cancers and associated mortality through effective screening is widely acknowledged (Han-Mo Chiu, 2021). Notably, fecal immunohistochemistry testing (FIT) has led to improved early detection of CRC (2). However, FIT screening was suspended in Canada in the initial phase of the COVID-19 pandemic response. Specifically, in Ontario, the collection of FIT samples was suspended between March 23rd, 2020 and August 26th, 2020 (3). During this 3-month period, an estimated 540,000 Canadians would have participated in screening, as indicated by OncoSim, a microsimulation model for cancer (4). The primary objective was to evaluate the consequences of screening cessation, through comparison of asymptomatic and symptomatic CRC diagnoses at the Windsor Regional Cancer Centre in Windsor, Ontario. Methods: A retrospective chart review was performed for patients admitted to the Windsor Regional Cancer Centre of Windsor Regional Hospital between December 2016 and June 2021. Demographic data, risk factors for CRC, cancer operability status, and the presence of symptoms at diagnosis of CRC were recorded. Results: 771 patient charts were reviewed and 77 (10%) were excluded due to duplication or insufficient chart data. Of the remaining 694 patients, 545 (79%) were classified as the pre-COVID group (December 2016 to February 2020) and 149 (21%) as the COVID group (March 2020 to June 2021). We found a 2.5% increase in symptomatic diagnoses of CRC in patients diagnosed after March 2020 (pre-COVID group vs. COVID group). However, we did not observe a significant difference in proportion of inoperable CRC cases between groups. Conclusions: The observed trend of symptomatic diagnoses of CRC underscores the importance of FIT screening for early CRC detection and the need for increased catch-up screening to mitigate the potential risks and mortality associated with CRC screening interruptions. For this, it is presumed that a population of patients exists who would have tested positive through FIT screening but instead presented symptomatically at a later stage of the disease. It is also important to note that our study data did not extend beyond June 2021, so we could not capture the complete impact of FIT cessation. (1) Canadian Cancer Statistics, 2021. (2) Zauber, 2015. (3) Ontario Health, 2021. (4) StatCan, 2021.
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