When will the backlog of colon cancer screenings subside?

Steep declines in colorectal cancer screening after the onset of the COVID-19 pandemic have gastroenterologists concerned about missed opportunities for early detection of colorectal cancer. 

Four leaders in gastroenterology spoke with Becker ASC Review on when they think the industry will recover from backlogs. 

Editor's note: These responses were edited lightly for clarity. 

George Dickstein, MD. Gastroenterologist at Greater Boston Gastroenterology: By most estimates it will be years, and the human and financial cost in missed opportunities to find colon cancer early or prevent it by adenoma removal is difficult to fathom. Groups traditionally challenged by healthcare disparities will be even more disadvantaged in this regard. This challenge is further compounded by the lack of anesthesiologists, CRNAs and endoscopists we are facing in many markets. 

Nationally, moratoria on elective procedures led to a steep dropoff in screenings for cancers, including colorectal cancer. In late summer of 2020, it was estimated that CRC screenings dropped by 86 percent  As a result of this challenge, some gastroenterologists advocate for more shared decision making with patients about noncolonoscopic modalities for screening, despite the superior performance of colonoscopy, as the backlog will take three to four years without this type of strategy. 

Vonda Reeves, MD. Gastroenterologist at GI Associates & Endoscopy Center (Flowood, Miss.):​ The second surge of the delta variant of COVID-19 has created yet another delay in delivery of gastroenterology services. As a result, we have had to again shift schedules that are not yet back at pre-COVID-19 levels. It is fair to anticipate a 12-18 month recovery time with caveats of only minor surges of new variants, which are to be expected. Staffing changes, whether from ill employees, quarantine status or departure from the medical field, will influence recovery time. Unfortunately, all of the above will delay care and diagnosis of malignancy and other treatable gastrointestinal disorders.

Lawrence Schiller, MD. Program Director of the gastroenterology fellowship at Baylor University Medical Center (Dallas): The current surge in COVID-19 cases seems to be subsiding, but it is unclear whether it will be the last. Too many susceptibles remain — up to 30 million children and 70 million unvaccinated adults in the US — and hospitalizations and deaths are still high. Demand for services will be suppressed, at least for the next few months, but will then explode as the backlog of cases is dealt with. It likely will take 12-18 months before business gets back to the pre-pandemic steady state.

Brian Dooreck, MD. Gastrointestinal Diagnostic Centers and the Memorial Healthcare System (Miami): We will recover. I think there was around a 25 percent reduction in colonoscopies performed during 2020. I read 10 million cancer screenings overall were missed during the pandemic. The real question is: How many will have died from not being screened for colorectal cancer? 

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