We recognize the ongoing impact of COVID-19 and the dynamic nature of the pandemic on Central Cancer Registries staff, resources and processes. One of the issues that needs our attention is the effect of COVID 19 on cancer incidence rates for 2020. We know, given the shut-down that occurred in many states, including the cessation of cancer-directed surgeries for many months, that we will see a decline in cancer incidence due to the fact that fewer cases were diagnosed during this period. This observation is substantiated by analysis conducted at SEER that shows a marked (~ 10%) decrease in pathology report filings during the pandemic, and a very slow return to pre-COVID levels, that is just now becoming evident a year later. The work of cancer registries, both population-based and hospital based, was also disrupted for many months due to policies that denied access to medical records, prohibited auditing, and required new policies surrounding remote access to data and working from home. The decline in cancer incidence combined with delays in reporting makes it especially challenging to understand the impact of COVID 19 on cancer data.
How will we determine that declines in case numbers are due to under-diagnosis, vs. under-reporting?
NPCR, SEER, and NAACCR have been discussing this topic in depth. Our first indication will come from the Calls for Data later this year. NPCR, NAACCR, and SEER all ask for submission of 2020 data as part of the call for data this fall. Comparing the case counts on this initial submission of 2020 data to previous submissions will be our first direct quantitative indicator of the magnitude of the problem. We hope to look at these case counts by site, and area of the country to better understand the impact of the pandemic on cancer incidence. SEER, NPCR, and NAACCR plan to collaborate on analyses of these preliminary data, supplemented by information on pathology report filings, abstract counts, and case counts to determine if readjusting the target completeness estimates for registries is necessary for 2020 data submitted in the fall of 2022. If so, these revised estimates will be developed next spring. We encourage all central registries to submit all of their 2020 cases during the Call for Data this fall, so that we have representative data on which to base our analyses to understand the full extent of the expected shortfall in 2020 cases.
We realize that none of the methods we currently use to evaluate completeness will be valid for 2020 data, and thus we will be working collaboratively with input from registries to develop a plan. Ultimately, our common goal is to produce timely and accurate data about cancer incidence during the pandemic, and we have agreed to work together to achieve this goal. If you have thoughts about how to address this issue, or concerns about methods, please feel free to reach out to any of us.