Is COVID-19 impacting cancer screening in Pakistan? An observational study of cancer screening test requests during the pandemic

BACKGROUND: The purpose of this study is to assess how the COVID-19 pandemic affected cancer screening at a large tertiary care setting in the city of Karachi, the third largest city in the world, and to identify if there has been any decrease in cancer screening during the ongoing pandemic. METHODS: A retrospective observational study was conducted at the clinical chemistry laboratory at the Department of Pathology & Laboratory Medicine, Aga Khan University Hospital (AKUH), Karachi Pakistan. Data for test volumes was extracted from the Integrated Laboratory Management System (ILMS) for the following tumor markers: CA19 Carbohydrate Antigen 19-9 (CA 19-9), Calcitonin, Prostate Specific Antigen (PSA), from 2017 to 2020. Data from January 1st, 2017 till December 31st, 2019 was recorded and compared with the test volume data from January 1st, 2020 till December 31st, 2020. Number of tests performed in the prior 3 years were compared with tests performed in 2020, specifically looking at changes during the lockdown period in 2020 (1st March – 9 th April) and compared with the same period in preceding years. RESULTS: During the four-year period, a total of 6,530 tests were performed for CA19-9, 893 for Calcitonin, and 54,769 for PSA. Year 2019 recorded the highest volume for all 3 tests with test volumes increasing continuously from 2017 to 2019. Number of tests performed decreased throughout the year 2020 for Calcitonin and PSA, whereas volume of tests for CA19-9 only reduced during the lockdown period while increased in the non-lockdown period as compared to previous years. Highest percent decline during the 2020 lockdown period was seen for Calcitonin (-62.5%), followed by PSA (-51.8%) and CA19-9 (-19%). CONCLUSION: In conclusion, the amount of CA19-9, Calcitonin, and PSA tests performed in Karachi, Pakistan has drastically reduced due to the lockdown that was mandated due to the COVID-19 outbreak. It is crucial that despite an imposed lockdown, regular cancer screening must continue.