Assessing the impact of the COVID-19 pandemic on the diagnosis and staging of pancreatic cancer: A Surveillance, Epidemiology and End Results analysis.

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Background: The COVID-19 pandemic markedly affected the U.S. health care system and may have altered the diagnosis and management of pancreatic cancer. We examined national trends in pancreatic cancer diagnoses before and throughout the first two years after the onset of COVID-19 in the United States, using the latest data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We queried the SEER database for cases of pancreatic cancer diagnosed between 2019 and 2021 using ICD-O-3 codes C25.0-C25.9. Disease stage was categorised as localised, regional, distant, or unknown according to the SEER combined summary staging system. Case counts and incidence rates were compared across 2019, 2020, and 2021, with year-to-year differences assessed for statistical significance using χ² tests. Results: The overall number of cases of PDAC diagnosed in 2019, 2020, and 2021 (including year-to-year changes) were 13,457, 13,153 (-2.3%, p<0.05), and 13,998 (+6.4%, p<0.001). Among the known SEER summary staging for PDAC, 52.3% of cases were categorised as “distant” at the time of diagnosis in 2019, compared to 53.6% (+2.4%, p<0.05) in 2020, and 52.0% (-2.8%, p<0.05) in 2021. This reflected an overall change of -0.5% in “distant” PDAC diagnoses from 2019 to 2021 (p>0.05). Conclusions: Significantly fewer cases of PDAC were diagnosed in 2020 compared with 2019, followed by a significant increase in 2021 to above pre-pandemic levels. The proportion diagnosed as distant was significantly higher in 2020 than in 2019 but did not differ significantly between 2019 and 2021. These findings suggest a transient shift toward more advanced-stage PDAC diagnoses during the first year of the COVID-19 pandemic with likely delays in diagnosis, which returned to baseline in 2021.