Major Health Crisis Uncovered in Puerto Rico

Colorectal cancer diagnoses in Puerto Rico suffered a staggering decline during and after Hurricane Irma, Hurricane Maria, and the COVID-19 pandemic. What followed this downturn is equally troubling—an alarming surge in late-stage cancer diagnoses.

A recent analysis published in the journal Cancer reveals that disrupted access to critical screenings during these catastrophic events likely resulted in more patients diagnosed at advanced stages of the disease. This points to a desperate need for bolstered health care infrastructure in disaster-prone areas.

Experts Raise the Alarm on Healthcare Access

"The findings highlight that restricted health care access during these crises likely delayed cancer detection and negatively impacted health outcomes," stated Tonatiuh Suárez-Ramos, MS, co-lead author from the University of Puerto Rico Comprehensive Cancer Center. "This situation is particularly dire for Puerto Rico, where the healthcare system is already strained."

Diving into the Data: A Revealing Analysis

The researchers leveraged comprehensive monthly data from the Puerto Rico Central Cancer Registry, boasting a remarkable 95% completeness since 2010. They analyzed first-time colorectal cancer diagnoses among Puerto Rican residents from January 2012 to December 2021, identifying 18,537 cases while excluding those with missing data.

After careful adjustments, 18,089 patients were considered for the study. Diagnoses were classified by cancer stage and age, in line with established screening guidelines. What they found was startling.

How Disasters Impacted Diagnosis Rates

CRCs dropped dramatically in Puerto Rico immediately following Hurricane Irma and Maria, with an estimated 17.5% decrease in cases as the hurricanes hit. A further decline was noted after the onset of COVID-19 lockdowns, with a shocking 24.2% drop—39.4 cases less than expected. By study’s end, early-stage diagnoses continued to linger below anticipated levels.

In contrast, diagnoses among late-stage cancer patients, and those outside the preferred screening age bracket, exceeded predictions, suggesting that limited access to healthcare during these disasters escalated the severity of cases at the time of diagnosis.

Examining Limitations and Future Steps

While the study highlights critical trends, it does have limitations. Notably, data from beyond December 2021 are missing, which means the full impact of the COVID-19 pandemic remains unclear. Additionally, immigration patterns might have skewed the data, although collaboration with US registries helped capture some cases diagnosed elsewhere.

Despite these hurdles, this is the first interrupted time series analysis in Puerto Rico to evaluate how significant disruptions affect colorectal cancer diagnoses.

A Call to Action for Better Healthcare Solutions

"Our hope is to spark a dialogue on long-term strategies to enhance cancer care coordination, minimize health disparities, and ensure persistent access to care," said Karen J. Ortiz-Ortiz, DrPH, senior author and associate investigator. "Ultimately, we aim to empower individuals to lead longer, healthier lives by building resilient healthcare systems, even in the face of crises."