{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:15:26Z","timestamp":1779250526483,"version":"3.51.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010249","name":"School of Medicine, Indiana University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010249","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>In two large university affiliated healthcare systems, we examined trends in colorectal cancer (CRC) screening both prior to and during the COVID-19 pandemic to compare the trends in non-invasive screening tests and colonoscopy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>In this retrospective time-trend analysis, we obtained the numbers of colonoscopies and non-invasive tests performed monthly during the pandemic and the year prior to it. We obtained colonoscopy data from five endoscopy units with the indication determined by dual independent review. Monthly numbers of completed fecal immunochemical (FIT) and FIT-DNA tests were obtained from the electronic medical records of both health systems. Trends in testing, numbers, and stage of incident CRCs diagnosed during the 30-month interval were examined using Poisson regression and logistic regression, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>From January 2019 to June 2021, we identified 16,939 FIT tests, 2,942 FIT-DNA tests, and 38,332 colonoscopies from the two health systems, and 368 colorectal cancers (105 early stage, 263 advanced stage) from the private hospital system. Overall colonoscopy volume declined by 18.7% (from 16,483 to 13,393) in 2020 compared to 2019 in both health systems, returning to baseline in 2021. Non-invasive tests declined by 21.9% in 2020, but increased in 2021 due to greater use of FIT\/DNA. Compared to 2019, incident CRCs declined in 2020 but rebounded in 2021, with no difference in early versus late-stage cancers.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These trends in CRC screening tests may be useful for modeling the effects of the pandemic on the longer-term outcomes of CRC incidence and mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317057","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T18:33:47Z","timestamp":1736188427000},"page":"e0317057","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of the COVID-19 pandemic on colorectal cancer screening in two university-affiliated health care systems"],"prefix":"10.1371","volume":"20","author":[{"given":"Vinod","family":"Kumar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-6701","authenticated-orcid":true,"given":"Lilian","family":"Golzarri-Arroyo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Roth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7586-1073","authenticated-orcid":true,"given":"Thomas F.","family":"Imperiale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"issue":"9","key":"pone.0317057.ref001","doi-asserted-by":"crossref","first-page":"998","DOI":"10.2174\/18735592MTEx9NTk2y","article-title":"Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes.","volume":"22","author":"F Baidoun","year":"2021","journal-title":"Curr Drug Targets"},{"issue":"10207","key":"pone.0317057.ref002","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/S0140-6736(19)32319-0","article-title":"Colorectal cancer.","volume":"394","author":"E Dekker","year":"2019","journal-title":"Lancet"},{"issue":"3","key":"pone.0317057.ref003","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.hoc.2022.02.001","article-title":"Screening for Colorectal Cancer.","volume":"36","author":"S. Gupta","year":"2022","journal-title":"Hematol Oncol Clin North Am"},{"issue":"4","key":"pone.0317057.ref004","doi-asserted-by":"crossref","first-page":"250","DOI":"10.3322\/caac.21457","article-title":"Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.","volume":"68","author":"AMD Wolf","year":"2018","journal-title":"CA Cancer J Clin."},{"issue":"10","key":"pone.0317057.ref005","doi-asserted-by":"crossref","first-page":"253","DOI":"10.15585\/mmwr.mm6910a1","article-title":"Vital Signs: Colorectal Cancer Screening Test Use\u2014United States, 2018.","volume":"69","author":"DA Joseph","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"17","key":"pone.0317057.ref006","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJMoa2208375","article-title":"Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death","volume":"387","author":"M Bretthauer","year":"2022","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0317057.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00384-022-04298-1","article-title":"Underestimating the benefits of screening colonoscopy for colorectal cancer","volume":"38","author":"SH Emile","year":"2023","journal-title":"Int J Colorectal Dis"},{"issue":"3","key":"pone.0317057.ref008","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1001\/jamaoncol.2020.7600","article-title":"Cancer Screening Tests and Cancer Diagnoses During the COVID-19 Pandemic.","volume":"7","author":"Z Bakouny","year":"2021","journal-title":"JAMA Oncol."},{"issue":"1","key":"pone.0317057.ref009","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1080\/13696998.2021.1886109","article-title":"Health outcomes and economic burden of hospitalized COVID-19 patients in the United States.","volume":"24","author":"M Di Fusco","year":"2021","journal-title":"J Med Econ"},{"issue":"3","key":"pone.0317057.ref010","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1053\/j.gastro.2022.05.014","article-title":"Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population","volume":"163","author":"JK Lee","year":"2022","journal-title":"Gastroenterology"},{"issue":"2","key":"pone.0317057.ref011","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/09691413221128666","article-title":"Impact of the COVID-19 pandemic on colorectal cancer screening in New York City.","volume":"30","author":"B Lee","year":"2023","journal-title":"J Med Screen"},{"key":"pone.0317057.ref012","article-title":"editors. Impact of the COVID-19 pandemic on colorectal and prostate cancer screening in a large US health system","author":"AH Kelkar","year":"2022","journal-title":"Healthcare"},{"issue":"11","key":"pone.0317057.ref013","doi-asserted-by":"crossref","first-page":"e2243119","DOI":"10.1001\/jamanetworkopen.2022.43119","article-title":"Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy.","volume":"5","author":"M Rottoli","year":"2022","journal-title":"JAMA Netw Open."},{"issue":"3","key":"pone.0317057.ref014","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S2468-1253(21)00005-4","article-title":"Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study","volume":"6","author":"EJA Morris","year":"2021","journal-title":"Lancet Gastroenterol 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