How the COVID-19 pandemic has affected the colorectal cancer screening in Italy: A minireview

Table 1 Studies reporting on the effects of coronavirus disease 2019 pandemic on colorectal screening in Italy

Ref.	Centers participating in the study	Time frame	Main conclusions
Armaroli et al[9]	20 out of 21 regions involved	January-May 2020 vs January-May 2019	(1) Cumulative delay of colorectal screening = 585.287 less exams (54.9%); (2) Esteemed delay of diagnosis of 3953 high-risk colonic adenomas and 611 colon cancer cases; and (3) Esteemed delay in diagnosis of 2.7 mo
Germana et al[10]	Veneto regional screening database	January-November 2020 vs same period in 2018-2019	(1) 453877 people invited to undergo FOBT, within the regional colorectal cancer screening program, 115976 fewer than the previous two years (-20.4%), with an adherence rate that dropped from 65.2% to 54.2%; (2) Colonoscopies fell by 22.2% (67138 in 2020 ss. 86298 for the years 2018-2019); and (3) The reduction was of 13.1% for screening colonoscopies following a positive FOBT, and 24.9% for non-screening colonoscopies
Buscarini et al[6]	49 units across Italy: 32 from the North (65.3%), 6 from the Center (12.2%), and 11 from the South (22.4%)	January-October 2020 vs same period in 2017, 2018 and 2019	(1) CRC new diagnoses decreased by 11.9%; and (2) The 2019–2020 comparison showed fewer CRC diagnoses in the North (-13.7%), Center (-16.5%) and South (-4.1%)
Ferrara et al[11]	7 Units in Northern-Central Italy	11th-20th week of 2020 vs same period in 2018 and 2019	Decrease of 46.6% of new colorectal cancer diagnosis with screening program (335 in 2018-2019 and only 178 in 2020)
De Vincentiis et al[7]	Single Unit audit	11th-20th week of 2020 vs same period in 2018 and 2019	CRC new diagnoses fell in 2020 by 62% compared with the average number in 2018 and 2019. CRC was identified as carrying a potentially important diagnostic delay
Maida et al[12]	121 Units from 20 Italian regions	Survey between March 30, 2020 and April 7, 2020	(1) 49 (46.7%) of 105 gastroenterology divisions had suspended their endoscopic screening program for colorectal cancer during the COVID-19 pandemic; (2) Overall, 10.7% Gastroenterology Divisions have been converted to Covid Units; and (3) Endoscopic procedures were limited to urgencies and oncology indications
Repici et al[13]	41 EUs across Northern Italy	Survey between March 16, 2020 and March 21, 2020	(1) 75%–99% reduction in activity in 28% of endoscopic units, a 50%–75% reduction in 9% of units, with only a single unit maintaining its workload unchanged; and (2) Most EUs limited their activity to urgent cases, including patients at high-risk of cancer

EUs: Endoscopic Units; CRC: Colorectal cancer; COVID-19: Coronavirus disease 2019; FOBT: Faecal occult blood test.