Now a perspective piece published in June 2020 in the journal Gastrointestinal Endoscopyreveals that the COVID-19 pandemic has exacerbated CRC screening disparities, threatening to undo progress made toward addressing these inequities. Because of the rapid spread of the coronavirus pandemic, which to date has resulted in more than 16 million infections and 660,000 deaths worldwide, the U.S. surgeon general advised a suspension of nonurgent medical procedures and surgeries, such as CRC screenings, which have dropped by an estimated 86 percent. While the study does not include hard data on rates of CRC screenings broken down by race, Dr. Balzora explains that “knowing the collateral damage that is a decline in screening rates in the midst of this pandemic, it is inevitable that the gap will widen in CRC disparities even further as those communities who were already disadvantaged are further crippled by the effects of the pandemic.” Balzora notes that African Americans, Hispanics, and Native Americans are also contracting COVID-19 and dying from it at higher rates than white people. Since the pandemic began, local and national events for medical counseling, educational tours, and recruitment of patients for CRC studies have been canceled. The absence of community outreach will result in an unforeseen challenge in relaying the importance of CRC screening to vulnerable populations.
A Way Forward to Close the Gap
While the global pandemic threatens to increase CRC screening disparities, the report includes a number of suggestions from researchers about how to protect those at risk and maintain scientific progress. In federally qualified health centers (FQHCs), the fecal immunochemical test (FIT) and fecal occult blood test (FOBT) are the preferred screening modalities. These noninvasive screenings analyze a patient’s stool for hidden blood and signs of colorectal polyps, which can be precancerous. Researchers urge FQHCs to consider implementing mailed FIT programs or contact-free pickup and return FIT/FOBT kits for patients so proper care can get underway before the end of the pandemic, which is unknown. “It is a complex situation that this pandemic has put us in,” Balzora says. “We have to prioritize what is the immediate killer, which is COVID-19, while still understanding the importance of CRC screening.” The study also suggests transitioning canceled events to virtual forums, similar to the 2020 Fight CRC Call-on Congress in March. When possible, these events should be held on the most accessible form of technology — telephones over video conferences — to accommodate more participants. Researchers emphasize that the only way to mitigate an exacerbation of CRC screening disparities due to COVID-19 is to devise a new way forward. And as healthcare centers begin to return to pre-coronavirus norms, Balzora says it’s important to prioritize those people who are at highest risk. “That these two diseases, CRC and COVID-19, disparately impact the same populations, I think is in largest part due to social determinants of health, and not genetics,” she says. “We don’t have all the answers to this, but this phenomenon is not a coincidence.” Ruth Wright, a hematology oncology consultant at the pharmaceutical company Celgene, says the huge disparities stem primarily from a lack of participation in research studies by those at higher risk. But, she adds, “a lot of patients that have been underrepresented in the past can be more fully represented in the virtual environment because some of the barriers have been taken away. “Transportation is a huge one. Getting off work is another huge one,” Wright says. “Even when we do go back to a more personal touch, … with our medical professionals, I hope that the virtual environment will continue for those patients.” Wright emphasizes that although virtual advocacy and at-home screenings are great efforts, keeping that momentum post-pandemic is necessary. “From my perspective in the healthcare industry, I do see a lot of positive movement toward that support and that care that is needed to bring people of color into the healthcare system in a more realistic and efficient way,” she says. Patients who have experienced cancellations of CRC screenings should place a request with their healthcare providers to receive an at-home test in order to complete their screenings as soon as possible. If test results come back positive, follow-up procedures and treatments can be scheduled and prioritized ahead of time as medical centers lift COVID-19 restrictions.
