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Preventive Care Takes Pandemic Hit, Results in Missed Diagnoses

2020 preventive care deficits indicate thousands of missed cancer diagnoses and millions in future healthcare costs, finds a Data insight from Xtelligent Healthcare Media

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- The normal course of preventive care procedures was broken during the height of the COVID-19 pandemic resulting in thousands of missed cancer diagnoses in 2020. Using private insurance claims data, Insights by Xtelligent Healthcare Media unveiled the personal and financial cost of missing these services.

Screenings, tests, and vaccinations used to detect or ward off serious diseases are a crucial part of early disease detection and reducing the long-term toll of cancers or other conditions on patients.

Mammograms, colonoscopies, and pap smears are all examples of preventive assessments experts recommend to monitor for signs of disease. These three screening tests seek indices of cancer in patients, and they can help doctors find cancers that may have otherwise gone undetected. Additionally, examinations of this sort are valuable early detection tools that allow doctors to diagnose and treat cancers before they progress to more costly late stages.

During the lockdowns of 2020, it became difficult for doctors to conduct ordinary measures like preventive screenings for cancer. Processes like provider symptom monitoring and masking were quickly implemented to ensure patient safety during routine care visits, but this adjustment precipitated an interruption in service. Improvised telehealth visits or at-home testing kits were not sufficient replacements for in-person procedures and the subsequent missed tests resulted in the forgoing of care that could have found early stages of cancer.

Early consequences reported by the National Cancer Institute showed an abrupt decrease in cancer screening of between 60 and 80 percent for some procedures throughout the spring of 2020.    

Using health insurance claims data from 2020 and historical cancer trends, Xtelligent Healthcare Media predicted the patient and financial impact these missed preventive screenings would have on the healthcare system.

Exactly how many screenings were missed during the pandemic will be revealed later when private insurers and the Centers for Medicare & Medicaid Services release all of their claims data. Yet, by looking at a sample of the currently available data from 20 million patients in 2020, staggering drops in preventive care are apparent:

  • 114,636 missed colonoscopies
  • 158,717 missed mammograms
  • 114,367 missed pap smears

This represents 25 percent, 16 percent, and 8 percent decreases from 2019, respectively.

Percentages of missed screenings from 2019-2020 are shown as white bodies.
Percentages of missed screenings from 2019-2020 are shown as white bodies.

Source: Xtelligent Healthcare Media, Created with Canva

The positivity rate for tests of breast cancer, colorectal cancer, and cervical cancer are relatively low: 0.005 percent for breast cancer, 0.004 percent for colorectal cancer, and 0.00026 percent for cervical cancer. While the preponderance of preventive tests find no cancers in a patient, these three tests are effective at finding early stage cancers when the disease is present.

Using standard positivity rates, approximately 459 colorectal cancer cases, 794 breast cancer cases, and 30 cervical cancer cases went undiagnosed in 2020.  

Cost of care for the first year of these cancer treatments fluctuates based on several factors like stage of disease, course of treatment and age of patient. For this analysis, cost assessments of first year treatment for adults under 65 were used to evaluate probable cancer treatment expenditures in 2021.   

According to estimations for diagnoses and average annualized treatment costs, it is likely that patients in the sample population with postponed diagnoses will pay approximately $2 million for cervical cancer, $27.5 million for breast cancer and $35.7 million for colorectal cancer. If undiagnosed cases progress without treatment, the continued cost of care for patients will be even higher.

These cancer cost estimates increase when looking at the total number of privately insured Americans. When the costs from sample claims data is inferred to all 220 million privately insured patients, spending projections grow 11 times, which translates to $392.7 million for colorectal cancers, $302.5 million for breast cancers, and $22 million for cervical cancers.

Aside from the financial impact, these delayed diagnoses would amount to 5,049 cases of colorectal cancer, 8,734 cases of breast cancer, and 330 cases of cervical cancer.

If testing is not hastily conducted for all patients that missed out on screening, there could be an influx of later stage cancers that were left unchecked. For some patients this could mean more intense treatment and a serious prognosis.

Hospitals and healthcare systems have modernized their strategies to accommodate for patients who could not receive preventive care during the pandemic. Some care centers have dedicated more resources to giving patients the ability to test for disease at home using kits, such as:

Tests like these do not replace in-person screenings, and any positive results require that a patient follow up in person for evaluation. Other providers have already begun a push to boost preventive care visits now that COVID-19 vaccinations have become available.

Considering the prospect of millions of patients missing life-altering diagnoses, provider organizations should prioritize testing and screening. Hospitals or care centers in COVID-19 hotspots should ensure preventive screening efforts do not fall to the wayside, whether that means flagging patients in need to services when the COVID-19 influx wanes or investing in common at home tests that can help identify cancer. Rigorous preventive screening, conducted in a safe setting by physicians who can discern results, is the best option for avoiding unnecessary cancer risks.

Critically, organizations should arrange testing for all individuals who missed appointments in 2020 and are at high risk. Cancer is a disease that is best treated in its early stages; to wait to identify it in patients is akin to endangering those patients.

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