Issues

The cover image is adapted from Fig. 1 in the article, “Age-Specific Cancer Mortality in the US During the COVID-19 Pandemic, March–December 2020,” by Shiels and colleagues. There were major concerns early in the pandemic as to whether COVID-19 would also increase cancer death rates, either directly or indirectly. However, while deaths due to heart disease, stroke and diabetes all increased in 2020, the number of cancer deaths declined. To better understand the impact of the COVID-19 pandemic on cancer death rates in 2020 in the US, the authors estimated whether there were larger than expected changes in cancer mortality rates during March–December 2020 using data from January 2011–February 2020 by cancer type and age. After accounting for temporal trends and seasonal patterns, total cancer death rates were significantly lower than expected during March–December 2020 among 55- to 64-yearolds and ≥75-year-olds, but not in other age groups. Cancer death rates were 2% lower than expected from March–June among 55- to64-year-olds, and 2% to 3% lower from March–July and December among ≥75-year-olds. Among ≥75-year-olds, colorectal cancer death rates were lower in March–June (RRs 0.94-0.96; p<0.05); however, lung cancer death rates were 5% lower across each month (all RRs 0.95, p<0.05). Figure 1 shows the adjusted rate ratios comparing cancer death rates during the COVID-19 period (March–December 2020) to the pre-COVID-19 period (January 2011–February 2020) by month for select cancer types and age groups. In the US, cancer death rates based on the underlying cause of death were broadly similar to expected rates during March–December 2020. However, cancer death rates were lower than expected among 55- to 64-year-olds and ≥75-year-olds, likely due to COVID-19 as a competing cause of death. The decline in incidence coupled with declines in death rates with cancer as the underlying cause in certain age groups indicate that surveillance data in 2020 should be used with caution, and cancer death rates in 2020 should be interpreted in the context of reduced health care and competing causes of death during the pandemic. In addition, the long-term impact of the COVID-19 pandemic on cancer incidence and mortality remains unclear and requires continued surveillance. For more information, see the article beginning on page 1023.