When the COVID-19 pandemic began in the U.S. in 2020, most hospitals and physician’s offices paused elective and preventive care services to focus on treating large numbers of COVID patients, preserving medical supplies and bed space in hospitals, and reducing the risk of non-COVID patients being exposed to the virus. Cancer screenings were one of the services that were paused. In 2020, this pause resulted in an 86 percent to 94 percent drop in preventive cancer screenings compared to the same time period during the three previous years, according to data from 2.7 million electronic patient records representing 190 hospitals in 23 states. Another report, published in JAMA Open Network, found that in the early weeks of the pandemic, weekly diagnoses for breast, colorectal, lung, pancreatic, gastric, and esophageal cancer fell 46.4 percent. The decline was linked to the drop in screenings.
Although screenings rebounded and approached pre-pandemic levels during the summer of 2020, physicians have raised concerns that missed and delayed cancer screenings have the potential to lead to an increase in the number of people diagnosed with more advanced cancer and, possibly, 10,000 excess cancer deaths over the next decade. That concern was supported by data from the American Society of Radiation Oncologists, which noted that two-thirds of radiation oncologists surveyed noted new patients were being diagnosed with more advanced cancers.
Recently, the authors of the JAMA Open Network report updated their findings to include data on new cancer diagnoses through March 2021. They expanded the types of cancers included in the report, adding cervical and prostate cancer, and looked at new cancer diagnoses during three time periods—pre-pandemic (January 2019 to February 2020), pandemic period 1 (March to May 2020), pandemic period 2 (June to October 2020), and pandemic period 3 (November 2020 to March 2021). The data was drawn from the records of patients at Quest Diagnostics across the U.S. with orders that included ICD codes associated with the eight types of cancer.
They discovered that during pandemic period 1, diagnoses for all eight types of cancer decreased significantly, with the mean monthly number of new diagnoses decreasing 29.8 percent. For breast cancer, the decrease was 36.1 percent. In the second period, new cancer diagnoses rebounded to pre-pandemic levels, except in the case of prostate cancer.
However, in the third pandemic period, which coincided with the fall/winter 2020/21 rise in COVID cases, mean monthly numbers of newly diagnosed patients dipped again, falling significantly lower than pre-pandemic levels but not as low as in pandemic period 1 for all eight types of cancer. The current surge in COVID cases driven by the Delta variant may also drive down new diagnoses for the summer of 2021.
What does the drop in cancer screening and diagnosis mean for patients?
Delaying recommended cancer screenings has the potential to increase the risk of being diagnosed with more advanced cancer that’s more complex to treat and may be associated with poorer outcomes.
If you are anxious about getting screened and potential exposure to health care staff and other patients who may not be vaccinated or who may have an undiagnosed, asymptomatic COVID infection, the first step to getting the screenings you need is to call your doctor to talk about your concerns. Ask what steps are being taken to protect patients (physical distancing in the waiting room, limiting the number of patients in the waiting room, required face masks and appropriate PPE for patients and staff, regular cleaning and disinfection of equipment and surfaces, vaccination requirements for staff).
You should talk with your doctor about the risks of postponing screening. Factors to discuss include:
- Your personal and family medical history
- When you were last screened
- History of cancer
- Other factors that may increase your risk of cancer including genetic mutations associated with increased cancer risk, lifestyle factors like smoking, alcohol use, excess sun exposure, and age
You can also ask if there are other appropriate, effective forms of screening. For example, there are several different types of screening tests for colorectal cancer, including fecal immunochemical testing (FIT) or a stool DNA test that can be done at home, although colonoscopy remains the gold standard for screening.
If you’re experiencing any symptoms that may be related to cancer, such as a lump in the breast, changes in a mole, difficulty swallowing, or blood in the stool, contact your doctor right away to schedule the needed diagnostic tests and follow-up.
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