The COVID-19 Pandemic and Changes in Cancer Screening Disparities from 2015 to 2023: An NSHAP Survey Study

BACKGROUND: From 1990 to 2020, cancer screening rates in the United States steadily rose, but disparities persisted. Cancer screening was disrupted by the COVID-19 pandemic, possibly worsening disparities. OBJECTIVE: We utilized a longitudinal cohort of age-eligible adults to examine pre-pandemic (2015-16) and late-pandemic (2021-23) cancer screening rates to evaluate health disparities. DESIGN: This is a study of participants who completed National Social Life, Health, and Aging Project (NSHAP) surveys in 2015-16 and 2021-23. We used univariable and multivariable logistic regression analyses to measure differences by age, gender, race and ethnicity, education level, marital status, and income in screening for colorectal, prostate and breast cancer. PARTICIPANTS: We studied data from 2,585 NSHAP participants who completed both surveys. MAIN MEASURES: Self-reported past-year colorectal, breast, and prostate cancer screening rates completed with colonoscopies, mammograms, and prostate-specific antigen (PSA) testing, respectively. KEY RESULTS: The proportion of respondents completing colonoscopies, mammograms, and PSA testing did not change across surveys. Younger individuals (aged < 60) had lower mammogram rates in 2015-16 (52.8% vs. 62.9%, p = 0.04) and lower PSA testing in both surveys (37.0% vs. 53.5%, p < 0.001 and 34.3% vs. 45.3%, p = 0.04). Hispanic respondents had the lowest colonoscopy screening rates in 2015-16 (12.1%, p = 0.006) and 2021-23 (7.6%, p = 0.002), and Black women had the highest for mammograms in 2015-16 (65.3%, p = 0.04). Non-partnered men had lower PSA testing than partnered men in both surveys (p = 0.02 and p = 0.005). All screening rates were lower for those with lower incomes in 2015-16 (p < 0.05 for all). Analyses did not show significant demographic differences in screening rates over time. CONCLUSIONS: Overall population cancer screening rates remained consistent from 2015-16 to 2021-23. Demographic differences in cancer screening rates persisted, with no subgroups disproportionately affected by the COVID-19 pandemic. Targeted outreach is needed for demographic subgroups such as Hispanic individuals with persistently low colorectal cancer screening rates.