Differential impact of COVID-19 on cancer diagnostic services based on body regions – A public facility-based study in Hong Kong.

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A reduction in cancer services during the COVID-19 pandemic has impacted cancer diagnosis. The purpose of this study is to quantitatively determine the impact on cancer diagnostic service in public facilities across Hong Kong. Quantifying the temporal changes in the number of cancer diagnosis before, during and after the outbreak, is useful to establish the scale of the problem and to assess if there has been an adequate level of response.Retrospective cohort study using a territory-wide database in Hong Kong from 2017 to 2020 using consecutive specimens received for pathological diagnosis in public laboratories in 41 hospitals were retrieved.In 2020, a total of 455,453 pathological specimens were received, which amounted to a 15.5% reduction compared to prior 3-year average (p-value < 0.001). Analysis on confirmed malignant pathological diagnosis revealed a statistically significant reduction in colorectal (-10.0%, p-value < 0.001), prostate (-19.7%, p-value < 0.001), non-significant reduction for lung (-3.0%, p-value = 0.0526), and a marginal but non-significant increase for breast (0.7%, p-value = 0.7592) regions. Based on time series projection data, the estimated missed cancers for the 3 regions with reduced investigations were colorectal (10.0%), lung (3.0%) and prostate (19.7%).Variable impact on actual malignant pathological diagnoses based on 4 body regions was observed, with a statistically significant reduction in colorectal, lung and prostate regions, marginal but insignificant increase in breast regions. The findings could help public health policy future planning and intervention.

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Authors: Varut Vardhanabhuti, Kei Shing Ng