The impact of the temporary suspension of national cancer screening programmes due to the COVID-19 epidemic on the diagnosis of breast and colorectal cancer in the Netherlands

(2020) 13:147 Dinmohamed et al. J Hematol Oncol https://doi.org/10.1186/s13045-020-00984-1 LETTER TO THE EDITOR Open Access The impact of the temporary suspension of national cancer screening programmes due to the COVID‑19 epidemic on the diagnosis of breast and colorectal cancer in the Netherlands Avinash G. Dinmohamed1,2,3* , Matteo Cellamare1, Otto Visser4, Linda de Munck1, Marloes A. G. Elferink1, Pieter J. Westenend5,6, Jelle Wesseling7,8, Mireille J. M. Broeders9,10, Ernst J. Kuipers11, Matthias A. W. Merkx12,13, Iris D. Nagtegaal14,15 and Sabine Siesling1,16* Abstract Oncological care was largely derailed due to the reprioritisation of health care services to handle the initial surge of COVID-19 patients adequately. Cancer screening programmes were no exception in this reprioritisation. They were temporarily halted in the Netherlands (1) to alleviate the pressure on health care services overwhelmed by the upsurge of COVID-19 patients, (2) to reallocate staff and personal protective equipment to support critical COVID-19 care, and (3) to mitigate the spread of COVID-19. Utilising data from the Netherlands Cancer Registry on provisional cancer diagnoses between 6 January 2020 and 4 October 2020, we assessed the impact of the temporary halt of national population screening programmes on the diagnosis of breast and colorectal cancer in the Netherlands. A dynamic harmonic regression model with ARIMA error components was applied to assess the observed versus expected number of cancer diagnoses per calendar week. Fewer diagnoses of breast and colorectal cancer were objectified amid the early stages of the initial COVID-19 outbreak in the Netherlands. This effect was most pronounced among the age groups eligible for cancer screening programmes, especially in breast cancer (age group 50–74 years). Encouragingly enough, the observed number of diagnoses ultimately reached and virtually remained at the level of the expected values. This finding, which emerged earlier in age groups not invited for cancer screening programmes, comes on account of the decreased demand for critical COVID-19 care since early April 2020, which, in turn, paved the way forward to resume screening programmes and a broad range of non-critical health care services, albeit with limited operating and workforce capacity. Collectively, transient changes in health-seeking behaviour, referral practices, and cancer screening programmes amid the early stages of the initial COVID-19 epidemic in the Netherlands conjointly acted as an accelerant for fewer breast and colorectal cancer diagnoses in age groups eligible for cancer screening programmes. Forthcoming research is warranted to assess whether the decreased diagnostic *Correspondence: ; 1 Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Dinmohamed et al. J Hematol Oncol (2020) 13:147 Page 2 of 4 scrutiny of cancer during the COVID-19 pandemic resulted in stage migration and altered clinical management, as well as poorer outcomes. Keywords: COVID-19, Cancer, Incidence, Epidemiology, Registry, Population-based, Screening To the Editor, The chaos wreaked by COVID-19 catalysed a notable decrease in cancer diagnoses in the Netherlands compared with the period preceding the COVID-19 outbreak [1]. At the time when these findings were published, provisional data from the Netherlands Cancer Registry (NCR) on cancer diagnoses were available up to 12 April 2020 [1]. Therefore, the impact of the temporary halt of national population screening programmes for breast and colorectal cancer—which were halted as of 16 March 2020—could not yet be disentangled with the comparatively short observation period [1]. These programmes were halted to ease the burden on health-care services overwhelmed by the surge of COVID-19 patients, to reallocate personal protective equipment (PPE) to health care staff tackling COVID-19, and to mitigate the spread of COVID-19. The demand for critical COVID-19 care steadily decreased in the Netherlands since early April 2020. Consequently, hospital capacity for the diagnostic work-up of suspected cancer cases gradually re-established and PPE became increasingly available for a broad range of health care workers (e.g. radiographers and colonoscopists). Also, cancer screening units and waiting rooms were reorganised to minimise contracting COVID-19 in such environments. Therefore, invitations to screening programmes for colorectal and breast cancer gradually recommenced—albeit with limited operating and workforce capacity—as of mid-May 2020 and mid-June 2020, respectively. With more recent data available on cancer diagnoses up to 4 October 2020, we assessed the impact of the temporarily suspended national screening programmes on the initial pathological notification of ductal carcinoma in situ (DCIS) and invasive breast cancer—hereafter collectively designated as breast cancer—and colorectal cancer in the Netherlands. We selected patients diagnosed between 6 January 2020 and 4 October 2020 from the NCR that relies on pathological cancer notifications via the Nationwide Histopathology and Cytopathology Data Network and Archive. Of note, colorectal adenomas are not ascertained in the NCR. The expected number of newly diagnosed malignancies per calendar week during the study period was predicted using a dynamic harmonic regression model with ARIMA error components based on the observed weekly trends in cancer diagnoses in the period 2010–2019. The Additional file 1 provides methodological details. Breast cancer diagnoses among women aged < 50 or > 74 years (i.e. those not invited for biennial mammography screening) became significantly lower—as compared to the expected number of diagnoses—as of mid-March (Fi (...truncated)