Available online 7 December 2022, 102313

Author links open overlay panelABSTRACTBackground

The impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer screening participation is a global concern. A national database of screening performance is available in Japan for population-based cancer screening, estimated to cover approximately half of all cancer screenings.

Methods

Utilizing the fiscal year (FY) 2017–2020 national database, the number of participants in screenings for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (fecal occult blood test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear) were identified. The percent change in the number of participants was calculated.

Results

Compared with the pre-pandemic period (FY 2017–2019), in percentage terms FY 2020 recorded the largest decline in gastric cancer UGI series (2.82 million to 1.91 million, percent change was -32.2%), followed by screening for breast cancer (3.10 million to 2.57 million, percent change was -17.2%), lung cancer (7.92 million to 6.59 million, percent change was -16.7%), colorectal cancer (8.42 million to 7.30 million, percent change was -13.4%), cervical cancer (4.26 million to 3.77 million, percent change was -11.6%), and gastric cancer via endoscopy (1.02 million to 0.93 million, percent change was -9.0%).

Conclusion

The number of participants in population-based screenings in Japan decreased by approximately 10%–30% during the pandemic. The impact of these declines on cancer detection or mortality should be carefully monitored.

Section snippetsINTRODUCTION

Cancer screening in Japan is mainly divided into population-based cancer screenings conducted by local governments and worksite-based cancer screenings conducted by business owners for employees. A large-scale questionnaire survey conducted by the central government every three years estimated that about the same number of people who underwent worksite-based cancer screenings participated in population-based cancer screenings [1]. Currently, population-based cancer screening is the only

Data sources

Based on the national database [2], we identified the total number of participants nationwide from FY 2017 to FY 2020. The pandemic period and control period were considered to be FY 2020 (April 2020–March 2021) and FY 2017–2019 (April 2017–March 2020), respectively. The subjects of analysis were five cancer screenings recommended by the MHLW, and gastric cancer screening was performed separately by UGI and endoscopy (making six screening types in total). Furthermore, the number of participants

RESULTS

Table 1 shows the number of participants in FY 2020 and the average number of participants in the previous 3 years by sex, age group, and screening type. The number of participants in FY 2017–2019 was almost the same for each cancer type (Supplementary file). Compared with that before the pandemic, the total number of participants in FY 2020 decreased from 2.82 million to 1.91 million (gastric cancer, UGI), 1.02 million to 0.93 million (gastric cancer, endoscopy), 8.42 million to 7.30 million

DISCUSSION

This study revealed that the COVID-19 pandemic was associated with an approximately 10–30% decrease in the number of participants in Japanese population-based screenings. In percentage terms, gastric cancer screening had the greatest decrease in the number of participants. According to a previous study using a hospital-based cancer registry covering 70% of newly diagnosed cancers in Japan, of cancers diagnosed by screening in 2020 (by population-based screening and other screening types),

CONCLUSION

Based on a national database, the number of participants in population-based screenings in Japan decreased by approximately 10–30% during the pandemic. The impact of these declines on cancer detection or cancer mortality should be carefully monitored. As an intermediate step, it is important to monitor cancer screening attendance in the post-COVID-19 pandemic period to see if attendance returns to pre-COVID-19 pandemic levels.

Funding

This work was supported by Health and Labour Sciences Research Grants, and Research for Promotion of Cancer Control Programmes.

CRediT authorship contribution statement

Ryoko Machii and Hirokazu Takahashi contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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