Impact on the Volume of Pathology Reports Before and During the COVID-19 Pandemic in SEER Cancer Registries.

INTRODUCTION: Health care procedures including cancer screening and diagnosis were interrupted due to the COVID-19 pandemic. The extent of this impact on cancer care in the United States is not fully understood. We investigated pathology report volume as a reflection of trends in oncology services pre-pandemic and during the pandemic. METHODS: Electronic pathology reports were obtained from 11 U.S. central cancer registries from NCI's SEER Program. The reports were sorted by cancer site and document type using a validated algorithm. Joinpoint regression was used to model temporal trends from January 2018 to February 2020, project expected counts from March 2020 to February 2021 and calculate observed-to-expected ratios. Results were stratified by sex, age, cancer site, and report type. RESULTS: During the first 3 months of the pandemic, pathology report volume decreased by 25.5% and 17.4% for biopsy and surgery reports, respectively. The 12-month O/E ratio (March 2020-February 2021) was lowest for women (O/E 0.90) and patients 65 years and older (O/E 0.91) and lower for cancers with screening (melanoma skin, O/E 0.86; breast, O/E 0.88; lung O/E 0.89, prostate, O/E 0.90; colorectal, O/E 0.91) when compared with all other cancers combined. CONCLUSIONS: These findings indicate a decrease in cancer diagnosis, likely due to the COVID-19 pandemic. This decrease in the number of pathology reports may result in a stage shift causing a subsequent longer-term impact on survival patterns. IMPACT: Investigation on the longer-term impact of the pandemic on pathology services is vital to understand if cancer care delivery levels continue to be affected.

Bias Introduced by Relying on Incomplete Electronic Pathology Reporting for Rapid Case Ascertainment in Patient Contact Studies.

BACKGROUND: Relying on electronic pathology (ePath) reporting to state cancer registries for rapid ascertainment of cases for patient contact research studies may introduce bias if the patient populations differ for reporting facilities with vs without ePath. We examined changes between 2014-2019 in the percent of cases reported to the New York State Cancer Registry by ePath within 3 months of diagnosis and characteristics of the most recent cases by ePath status. Our goal was to assess the potential bias introduced by relying on incomplete ePath reporting for patient recruitment. METHODS: We restricted our analysis to first malignant cancers diagnosed in New York State residents aged 18 years and older. We examined patient characteristics and used χ2 tests to examine differences in the distribution of each characteristic by ePath status for diagnosis years 2017-2019, and used multivariable-adjusted logistic regression to calculate odds ratios and 95% CIs for the association between each patient characteristic and ePath status for all 2017-2019 cancers combined and common cancer sites. All analyses were conducted using SAS 9.4. RESULTS: The percent of cases reported by ePath increased over time from 15.7% in 2014 to 44.8% in 2019. Among 264,607 cancers diagnosed in 2017-2019 and reported through July 2021, there were statistically significant differences in all variables examined by ePath status (all P < .0001). For all cancers combined, cases reported by ePath were more likely to be younger, female, non-Hispanic White, married, live outside of New York City/ Long Island, still be alive, and have received treatment. We observed statistically significant odds ratios for the associations between all variables examined and ePath status for all cancers combined, but the strength and statistical significance of the associations varied by cancer site. CONCLUSIONS: Our results indicate that relying on incomplete ePath reporting for rapid case ascertainment will introduce selection bias in the study sample for patient contact studies. This bias should decrease as additional facilities acquire ePath reporting capability.

Distribution of treatment for human papillomavirus-associated gynecologic carcinomas before prophylactic vaccine.

BACKGROUND: This report describes the distribution of treatment for cervix uteri, vagina, and vulva carcinomas by demographic characteristics before the widespread implementation of human papillomavirus (HPV) vaccination in the US. METHODS: The authors used data collected by the Surveillance, Epidemiology, and End Results Program from 2000 through 2004 to calculate the distribution of surgical procedures and radiotherapy by carcinoma site, disease stage, and tumor histology (squamous vs nonsquamous). For women with localized cervical carcinomas, the proportions of hysterectomy procedures were analyzed by age, race, ethnicity, marital status, and histology, including a 13-year trend analysis of hysterectomy use. RESULTS: Although 75% of the women with cervical carcinomas underwent hysterectomy, there were significant differences in treatment by race and ethnicity. Black women were least likely to undergo hysterectomies: The large gap between them and other racial/ethnic groups persisted throughout the study period. For all 3 carcinoma sites, both tumor histology and disease stage influenced radiotherapy modality and the extent of surgery. Nonsquamous histology, ages 30 to 64 years, Asian/Pacific Islander race, and marriage were associated positively with hysterectomy. Overall, a gradual decrease in hysterectomy use was observed over time. Hysterectomies among Hispanic white women increased slightly. CONCLUSIONS: Cancer surveillance data suggest that treatment patterns of HPV-associated carcinomas are correlated with both clinical and demographic characteristics. The decreasing use of hysterectomy before introduction of the HPV vaccine and the vaccine's potential effect on the age-related stage distributions warrant consideration when evaluating its future impact on the delivery of care for women with HPV-associated tumors.

Geographic variation in the incidence of colorectal cancer in the United States, 1998-2001.

BACKGROUND: This study examined the incidence rates and risk factors for colorectal cancer in 9 geographic divisions in the United States. METHODS: The colorectal cancer cases were diagnosed between 1998 and 2001 in 39 states and the District of Columbia (grouped into 9 geographic divisions in the United States). The association between colorectal cancer and geographic division was analyzed using the Poisson regression model controlling for demographics and ecologic measures of education, behavioral factors and colorectal cancer screening data extracted from the Behavioral Risk Factor Surveillance System. RESULTS: The age-adjusted incidence rates of colorectal cancer were highest in the Middle Atlantic division, followed by New England division, East and West North Central divisions, East South Central and South Atlantic divisions, West South Central and Pacific divisions, with the lowest rate observed in the Mountain division. Old age, male gender, black race, less than a twelfth-grade education, smoking, and no physical activity were significantly associated with higher incidence rates of colorectal cancer, whereas having sigmoidoscopy/colonoscopy in the past 5 years, fecal occult blood test in the past year, and obesity were associated with lower incidence rates of colorectal cancer. The relative ranking of incidence rates of colorectal cancer across divisions changed after adjusting for these factors. CONCLUSIONS: Significant geographic variation in colorectal cancer exists in the United States. Risk factors, including demographics, education, behavior, and screening use, can only partially explain the differences across geographic divisions.