Positive trend in participation in early cancer detection
23.11.2023 15:30
After sharp declines in participation in cancer screening examinations in the “pandemic years” of 2020 and 2021 as well as in the Omicron wave at the beginning of 2022, participation numbers have largely returned to normal in the last few months. The German Cancer Society and the AOK Federal Association point this out on the occasion of the annual “Cancer Prevention Day” on November 28th. They welcome the positive trend, but also point out that there is still a lot of catching up to do due to missed examinations during the pandemic and generally large gaps in the regular use of cancer prevention.
According to the current “Early Detection Monitor” from the AOK Scientific Institute (WIdO), participation rates in cancer screening examinations in the second half of 2022 were back at the level of the comparable period in 2019 for most examinations, i.e. before the outbreak of the pandemic (Figure 1). This positive trend continued in the first quarter of 2023; Some studies even showed significant increases compared to the comparable year 2019.
“Against the background of the decline in early cancer detection during the pandemic, this normalization of use is a very positive development,” emphasizes Prof. Michael Ghadimi, President of the German Cancer Society. “The rule is: the earlier cancer or pre-cancerous lesions are discovered, the better the chances of recovery. That’s why we continue to appeal not to become careless when it comes to this issue and to attend early detection appointments.”
The detailed results of the WIdO evaluation for the 1st quarter of 2023 show a significant increase of almost 27 percent in colonoscopies as part of colon cancer screening compared to the 1st quarter of 2019. However, the increase may also have something to do with the fact that men Since 2020, people aged 50 and over have been able to take advantage of the examination. The result for mammography screening was 7.3 percent higher than in the first quarter of 2019, and for prostate cancer early detection it was 5.6 percent more. There was a slight decrease of 3.9 percent in the early detection of cervical cancer compared to the first quarter of 2019. There was a special effect in skin cancer screening: According to the WIdO, the decline of 12 percent compared to the comparable year 2019 is mainly due to changes in the examination interval for the general health examination from two to three years. The general health examination is often carried out in combination with skin cancer screening.
“After many missed early detection examinations during the pandemic, many insured people are now apparently making up for what they missed and making appointments for cancer screening again,” says Jens Martin Hoyer, deputy chairman of the AOK Federal Association. “We want to support this together with the German Cancer Society through targeted information.” The AOK is once again offering the “Vorsorg-O-Mat” on its homepage for “Cancer Prevention Day”, which users can use after entering individual information such as age and Gender informed about the upcoming early detection examinations. In addition, the AOK offers information films on its homepage about the process and benefits of individual early detection examinations. Both partners will provide intensive information about the topic on their social media channels around “Cancer Prevention Day” on November 28th and encourage participation in the planned examinations.
“Pandemic gap” in colonoscopies
One focus of the new “Early Detection Monitor”, which the WIdO published for this year’s “Cancer Prevention Day”, is on colon cancer prevention. The effects of the pandemic on early detection colonoscopies, but also on diagnostic colonoscopies, are analyzed here. The evaluation shows that there were significant decreases in the total number of colonoscopies performed in the years 2020 to 2022 compared to 2019 (Figure 2). If you take the level in 2019, i.e. before the pandemic, as a reference, a total of 150,000 fewer AOK insured people received a colonoscopy. “If one assumes a similar development in the entire population, more than 400,000 people could be affected who would have received a colonoscopy under normal conditions,” emphasizes AOK board member Jens Martin Hoyer.
“This pandemic gap is unfortunate. As with many types of tumors, early detection also plays an important role in colon cancer. Removing precursors – so-called polyps – can prevent the cancer from developing in the first place. The earlier a tumor is discovered, the greater the probability that it has not yet spread and is curable or that progression of the disease can be prevented,” explains Ghadimi. “However, long-term consequences of not having colonoscopies only become apparent in studies after an observation period of ten years.”
Potential for increase in long-term use of colon cancer screening
In addition, the early detection monitor shows significant potential for increasing the long-term use of colorectal cancer screening. According to the WIdO analysis, only around 45 percent of eligible people who were 65 years old or older in 2021 received an outpatient or inpatient colonoscopy for early detection or diagnosis in the past ten years. According to the evaluation, the difference between men and women is small. If you add fairly regular use of the alternatively offered test for hidden blood in the stool (Fecal Occult Blood Test, or FOBT for short), the use rate increases by an average of eight percentage points for women between the ages of 65 and 80 and by eight percentage points for men five percentage points.