The impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer screening participation is a global concern. A national database of screening performance is available in Japan for population-based cancer screening, estimated to cover approximately half of all cancer screenings.
Utilizing the fiscal year (FY) 2017–2020 national database, the number of participants in screenings for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (fecal occult blood test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear) were identified. The percent change in the number of participants was calculated.
Compared with the pre-pandemic period (FY 2017–2019), in percentage terms FY 2020 recorded the largest decline in gastric cancer UGI series (2.82 million to 1.91 million, percent change was −32.2 %), followed by screening for breast cancer (3.10 million to 2.57 million, percent change was −17.2 %), lung cancer (7.92 million to 6.59 million, percent change was −16.7 %), colorectal cancer (8.42 million to 7.30 million, percent change was −13.4 %), cervical cancer (4.26 million to 3.77 million, percent change was −11.6 %), and gastric cancer via endoscopy (1.02 million to 0.93 million, percent change was −9.0 %).
The number of participants in population-based screenings in Japan decreased by approximately 10–30 % during the pandemic. The impact of these declines on cancer detection or mortality should be carefully monitored.
- • COVID-19 has been reported to affect cancer screening participation.
- • % change in screening participation in Japan before/during COVID-19 was calculated.
- • Participants in population-based screening decreased by 10–30 % during the pandemic.
- • Impact of these declines on cancer detection or mortality should be monitored.
- • In the post COVID era, it will be important to monitor cancer screening attendance.
Cancer screening in Japan is mainly divided into population-based cancer screenings conducted by local governments and worksite-based cancer screenings conducted by business owners for employees. A large-scale questionnaire survey conducted by the central government every three years estimated that about the same number of people who underwent worksite-based cancer screenings participated in population-based cancer screenings . Currently, population-based cancer screening is the only national cancer control program, and it is implemented based on the guidelines of the Ministry of Health, Labor and Welfare (MHLW). Only the results of the population-based cancer screenings are collected annually by the MHLW from the local government and published as a national database on their website .
In a population-based cancer screening, the following programs are recommended by the MHLW : gastric cancer screening (upper gastrointestinal [UGI] or endoscopy, every 2 years for individuals aged ≥50 years; annual UGI is also available for individuals aged 40–49 years), colorectal cancer screening (annual fecal occult blood test [FOBT] for individuals aged ≥40 years), lung cancer screening (annual chest x-ray for individuals aged ≥40 years), breast cancer screening (mammography, every 2 years for individuals aged ≥40 years), and cervical cancer screening (Pap smear, every 2 years for individuals aged ≥20 years). Population-based cancer screening is divided into two types of screening system, one is conducted at large-scale facilities for large groups (mass screening), and the other at local medical facilities (individual screening). Local governments set limits on the number of participants for each type according to screening capacity, and residents are free to choose either type.
A national database of population-based screenings is constructed every fiscal year [FY]. This database includes the number of participants, and this is identifiable by the national total, local government, sex, age, and type of screening (mass screening, individual screening).
Globally, the number of cancer screening participants decreased significantly during the pandemic period, raising concerns about delays in cancer diagnosis and treatment . In FY 2020, the Japanese government declared a state of emergency nationwide only once from April 7 to May 25 . The MHLW had requested local governments to temporarily suspend or postpone population-based screenings during the declaration period, and compliance was dependent on each municipality. The aim of this report was to evaluate the changes in the number of population-based cancer screening participants during the COVID-19 pandemic in Japan, using national data.