Site-specific patterns of early-stage cancer diagnosis during the COVID-19 pandemic

Sep 21, 2026

The COVID-19 pandemic caused widespread disruptions in cancer care, particularly affecting diagnosis pathways for screen-detected cancers. Using newly diagnosed patients (age ≥18) from 2019–2020 in the US National Cancer Database, the study quantified changes in early- versus late-stage proportions via weighted linear regression. Disruptions were larger for early-stage than late-stage diagnosis (17% vs 12.5%), with melanoma showing the greatest relative decrease. Uninsured patients experienced greater disruptions than privately insured patients. Findings indicate that 2020 disruptions disproportionately impacted early-stage disease, especially screen-detected cases, supporting a role for primary care visits in early melanoma detection.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract

Study hypothesis and design

Key findings by cancer site and insurance status

Implications for early detection

JNCI Cancer Spectrum, 2024, 8(3), pkae022 [https://doi.org/10.1093/jncics/pkae022](https://doi.org/10.1093/jncics/pkae022) Advance Access Publication Date: March 23, 2024 Brief Communications Site-specific patterns of early-stage cancer diagnosis during the COVID-19 pandemic Connor J. Kinslow , MD,1,2,‡ David M. DeStephano, MS,1,2,‡ Alfred I. Neugut, MD, PhD, MPH,2,3 Kekoa Taparra, MD, PhD,4 David P. Horowitz, MD,1,2 James B. Yu, MD, MHS,1,2 Simon K. Cheng , MD, PhD1,2,5,􀀃 1Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA 2Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA 3Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA 4Department of Radiation Oncology, Stanford University, Stanford, CA, USA 5Department of Radiation Oncology, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA 􀀃 Correspondence to: Simon K. Cheng, MD, PhD, Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA (e-mail: [sc3225@cumc.columbia.edu](sc3225@cumc.columbia.edu)) . ‡These authors contributed equally to this work. Abstract The COVID-19 pandemic caused widespread disruptions in cancer care. We hypothesized that the greatest disruptions in diagnosis occurred in screen-detected cancers. We identified patients (≥18 years of age) with newly diagnosed cancer from 2019 to 2020 in the US National Cancer Database and calculated the change in proportion of early-stage to late-stage cancers using a weighted linear regression. Disruptions in early-stage diagnosis were greater than in late-stage diagnosis (17% vs 12.5%) . Melanoma demonstrated the greatest relative decrease in early-stage vs late-stage diagnosis (22.9% vs 9.2%), whereas the decrease was similar for pancreatic cancer. Compared with breast cancer, cervical, melanoma, prostate, colorectal, and lung cancers showed the greatest disruptions in early-stage diagnosis. Uninsured patients experienced greater disruptions than privately insured patients. Disruptions in cancer diagnosis in 2020 had a larger impact on early-stage disease, particularly screen-detected cancers. Our study supports emerging evidence that primary care visits may play a critical role in early melanoma detection. The COVID-19 pandemic caused widespread disruptions in cancer care, including reductions and delays in screenings, diagnosis, billing, and treatment (1-5) . Intentional delays in primary care visits and screenings were recommended by authoritative bodies, such as the American Society of Clinical Oncology and American College of Surgeons (ACS) (2 ,3) . These delays are expected to cause an increased burden of cancer-related mortality in the coming years (6) . In the National Cancer Database (NCDB), the number of recorded cancer diagnoses decreased during the first year of the pandemic by 12.4% to 14.4%, with earlystage diagnoses preferentially affected (2 ,3) . Diagnoses by individual cancer sites did not consistently reflect overall trends, however, suggesting site-specific variations related to patterns of care (3) . Previous studies analyzed gross categories rather than disease-specific sites, precluding insights into the consequences of disruptions in clinical practice, screening, and early detection. We hypothesized that during the COVID-19 pandemic, the greatest disruptions occurred in screen-detected cancers, including cancers of the breast, prostate, colon/rectum, lung, and cervix. The NCDB (2022 submission) is a retrospective, nationwide dataset sponsored by the ACS and the American Cancer Society, constituting 70% of incident invasive cancers in t

FAQs

What disruption did the study focus on during the COVID-19 pandemic?

The study focused on disruptions in early-stage versus late-stage cancer diagnosis, hypothesizing the greatest impact on screen-detected cancers.

How were changes in early- and late-stage diagnoses analyzed?

Patients with newly diagnosed cancer from 2019 to 2020 were identified from the US National Cancer Database, and changes in early-stage to late-stage proportions were calculated using a weighted linear regression.

Which cancer type showed the greatest relative decrease in early-stage diagnosis?

Melanoma demonstrated the greatest relative decrease in early-stage versus late-stage diagnosis (22.9% vs 9.2%).

Who experienced greater diagnostic disruptions, and what does the study suggest about early detection?

Uninsured patients experienced greater disruptions than privately insured patients. The study supports evidence that primary care visits may play a critical role in early melanoma detection.

Sep 21, 2026

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