S0318 Impact of the COVID-19 Pandemic on Colorectal Cancer Screening Rates and Modalities in a Large Integrated Health System

INTRODUCTION: The novel coronavirus 2019 (COVID-19) pandemic has upended routine preventive care across the country We sought to quantify the impact of the pandemic on colorectal cancer (CRC) screening rates and modalities utilized in a large academic health system We hypothesized a drop in utilization of invasive screening modalities and a compensatory rise in non-invasive screening modalities METHODS: We performed a retrospective analysis in a large academic health system On 3/18/2020, all non-urgent elective endoscopic procedures were halted following recommendations from the United States Surgeon General We utilized electronic health record (EHR) data to identify all patients who completed a screening endoscopy (colonoscopy or flexible sigmoidoscopy), fecal im-munochemical test (FIT), computed tomography (CT) colonography, or stool DNA test during the cessation period (3/18/2020-5/4/2020) and during an equal time interval before the cessation (1/29/2020-3/17/2020) Our primary outcome was the total number of screening tests per day among primary care enrollees Secondary outcomes included utilization of each screening modality We used Student's t-tests to compare utilization rates before and after endoscopy cessation overall and for each modality RESULTS: In the period before COVID-19, the average screening rate was 64 1 ± 19 3 (Figure 1A), with colonoscopies (33 3 per day) and FIT (30 8 per day) comprising the majority of tests (Figure 1B) During the cessation period, the average daily screening rate declined to 12 1 ± 13 0 (Figure 2;P < 0 01) Colonoscopy saw the steepest decline (33 3 ± 11 2 to 0 2 ± 0 4 per day;P < 0 01) FIT use also declined significantly (30 8 ± 10 7 to 11 8 ± 12 9 per day;P < 0 01) but did begin to recover in later weeks of the cessation period (Figure 2) Colonoscopy and FIT made up 1 9% and 97 4% of tests, respectively, during the cessation period Use of flexible sigmoidoscopy, CT colonography, and stool DNA was sparse throughout the study period CONCLUSION: Utilization of CRC screening declined drastically in the wake of the COVID-19 pandemic, largely driven by a drop in invasive screening modalities We observed a concomitant increase in non-invasive screening modalities though not sufficient to compensate for the overall drop in screening This work highlights the impact of COVID-19 on preventive care and the need to promote non-invasive screening modalities until endoscopic capacity recovers