Differential Impact of COVID-19 on Cancer Diagnostic Services Based on Body Regions: A Public Facility-Based Study in Hong Kong

PURPOSE: A reduction in cancer services during the coronavirus disease of 2019 pandemic has affected cancer diagnoses. 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 diagnoses before, during, and after the outbreak is useful to establish the scale of the problem and assess if there has been an adequate level of response. METHODS AND MATERIALS: This is a retrospective cohort study using a territory-wide database in Hong Kong from 2017 to 2020, and consecutive specimens received for pathologic diagnosis in public laboratories in 41 hospitals were retrieved. RESULTS: In 2020, a total of 455,453 pathologic specimens were received, which amounted to a 15.5% reduction compared with the prior 3-year average (P < .001). An analysis of confirmed malignant pathologic diagnoses revealed a statistically significant reduction in colorectal (–10.0%; P < .001) and prostate (–19.7%; P < .001), nonsignificant reduction in lung (–3.0%; P = .0526), and a marginal but nonsignificant increase for breast (0.7%; P = .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%). CONCLUSIONS: Variable impact on actual malignant pathologic diagnoses based on 4 body regions was observed, with a statistically significant reduction in colorectal, lung, and prostate regions, and marginal but insignificant increase in breast regions. The findings could help public health policy with future planning and intervention.