Estimated effects of screening delay due to SARS-COV-2 pandemic on colorectal cancer mortality

Introduction: The Sars-CoV-2 pandemic has had a sudden, dramatic impact on healthcare activities In Italy, the implementation of colorectal cancer screening programs has had a significant effect on both incidence and mortality from the disease However, since the beginning of the pandemic, colorectal cancer screening programs have been suspended across the country Aims & Methods: To forecast the impact of the pandemic on colon cancer screening program by building a model applying negative foreseeing primarily in function of the time-delays in access to colonoscopy and comparatively adjusted mortality for up-stage migration of patients Estimates of the effects of time-delay on CRC stage and of stage on mortality were assessed by a meta-analytic approach Results: With a short delay of 0-3 months, 74% of the CRC are expected to be of stage I-II, while with a delay of 4-6 months we observe an increase in the stage I-II percentage (from 74% to 76%), and a corresponding decrease for stage III-IV (p=0 068) However, compared to 0-3 months delays, moderate (7-12 months) and large (>12 months) delays would lead to an increase in advanced CRC (from 26% to 29 % and 33%, respectively;p=0 008 and p12 months delay (p=0 005) Finally, we observed a significant change in mortality distribution by stage when comparing the baseline with the >12 months (p< 0 001) Conclusion: Our data indicates that delays beyond 4-6 months would negatively colon cancer screening by increasing disease mortality rates This would occur due to the progressive shift of colorectal cancers from early stages to more advanced ones In the view of possible future waves of Sars-Cov-2 or other pandemics, healthcare authorities need to urgently think on how to reorganize activities without breaking the workflow for high-impact diseases such as colorectal cancer