Abstract Background: Health care procedures including cancer screening and diagnosis were interrupted due to the COVID-19 pandemic; The extent of this impact on cancer care in the U.S. is not fully understood. We investigated pathology report volume as a reflection of trends in oncology services pre-pandemic and during the pandemic. Methods: Electronic pathology reports were obtained from 11 U.S. central cancer registries from NCI’s SEER Program. The reports were sorted by cancer site and document type using a validated algorithm. Joinpoint regression was used to model temporal trends from January 2018-February 2020, project expected counts from March 2020-February 2021 and calculate observed-to-expected ratios. Results were stratified by sex, age, cancer site and report type. Results: During the first three months of the pandemic, pathology report volume decreased by 25.5% and 17.4% for biopsy and surgery reports, respectively. The 12-month O/E ratio (Mar 2020-Feb 2021) was lowest for women (O/E 0.90) and patients 65 yrs. and older (O/E 0.91) and lower for cancers with screening (melanoma skin, O/E 0.86; breast, O/E 0.88; lung O/E 0.89, prostate, O/E 0.90; colorectal, O/E 0.91) when compared to all other cancers combined. Conclusions: These findings indicate a decrease in cancer diagnosis, likely due to the COVID-19 pandemic. This decrease in the number of pathology reports may result in a stage shift causing a subsequent longer-term impact on survival patterns. Impact: Investigation on the longer-term impact of the pandemic on pathology services is vital to understand if cancer care delivery levels continue to be affected.