John Abraham’s colonoscopy was postponed for several months due to the pandemic. When he finally got it, doctors found a growth too large to be safely removed during the scope exam. He had to wait a few weeks for surgery, then a few more to find out that it hadn’t turned into cancer yet.
“I absolutely wonder if I had been screened when I should have, if this would have been different,” and surgery could have been prevented, said Abraham, a mortgage banker in Peoria, Illinois.
Millions of colonoscopies, mammograms, lung scans, Pap smears, and other cancer screenings were suspended in the United States and elsewhere for several months last spring as COVID-19 flooded medical care.
Now researchers are studying the impact to see how many cancers have been missed and whether the tumors found since then are more advanced.
There are already indications of problems. Researchers from the University of Cincinnati found that when CT scans to check for lung cancer resumed in June, 29% of patients had suspicious nodules versus 8% in previous years.
Multiple studies suggest fewer cancers were diagnosed last year, likely because of less screening. About 75 cancer organizations have recently pushed for a return to prepandemic screening levels as quickly and safely as possible.
But tumors take years to develop, and some reports suggest that a few months of delay in screening for certain types of cancer may not have been as bad as feared. For example, researchers in the Netherlands discovered that the cancellation of the mammography program in that country did not lead to more cancers being detected at a late stage after resuming screening.
The pandemic has also spawned some creative solutions, such as a wider use of tests that can be done at home. In Philadelphia, a large church partnered with local doctors and used its drive-thru flu shot program to also issue stool tests for colon cancer screening.
“We’re not afraid to try anything for health and wellness,” said Pastor Leroy Miles of Enon Tabernacle Baptist Church. The women encouraged men to undergo the screening and said, ‘I have my mammogram.’ And I say, “Madam, you also have a colon.” ”
THE REVENUES OF SCREENING
Screening tests differ in their risks and benefits, and health experts have long debated who should get which and how often. The expiration of the pandemic can serve as a “natural experiment” to see their value in modern times compared to what is known from studies conducted long ago.
Any difference in deaths may not be seen for years, and early detection is only one factor in survival. Treatment is important too, and it was hurt by pandemic delays too.
Dr. Ned Sharpless, director of the National Cancer Institute, estimates that there could be nearly 10,000 additional deaths over the next decade as a result of delayed detection and treatment for breast and colon cancer. Delaying concern “used to be wise” because of the risks of COVID-19 exposure, but delaying it for too long “can turn one public health crisis into many others,” he wrote in the journal Science.
Based on what is known about breast cancer deaths in the United States in recent years, about 10% “could have been prevented if women had been routinely screened,” but 20% to 25% could have been prevented with appropriate treatment, said Dr. Otis. Brawley, a professor at Johns Hopkins University and a former Chief Medical Officer of the American Cancer Society.
“That’s not to say that screening isn’t important, but a lot of people think cancer screening saves more lives than it actually does,” Brawley said.
A momentary delay cannot do much harm to mortality if screening resumes quickly, which is necessary, he said.
At a recent conference of the American Association for Cancer Research, there was reassuring news from Sabine Siesling of the Netherlands Comprehensive Cancer Organization. That country offers women ages 50 to 74 a mammogram every two years, but dropped out in mid-March due to COVID-19. After it resumed at the end of the summer, the results “showed no shift at all” towards more advanced tumors, she reported.
Researchers from Massachusetts General and Brigham and Women’s Hospital analyzed their screening tests for lung, cervix, colon, prostate and breast cancer. Screening dropped dramatically from March to June, but the proportion finding cancer or a precancer was higher than normal, suggesting that those who did screened were at higher risk. When screening returned to near normal from June to September, the number of possibly “missed” cancers was lower than expected.
GET CREATIVE
When 43-year-old actor Chadwick Boseman died of colon cancer last summer, Miles feared for the 12,000 members of his Philadelphia church. Black people are more likely to die from the disease than other groups, and there was limited access to colonoscopies, which can find and remove growths before they become cancer.
Miles, who has drawn more than 1,000 Church members to other health events, called the University of Pennsylvania and said, “We know how to get people to come if you’re willing and able to set something up.”
Dr. Carmen Guerra had a federal grant to increase screening in racially diverse communities and realized that home tests could help. Studies show that these tests, which look for blood in the stool, help save lives. People put a small stool sample in a tube and send it to a lab or, in this case, use a dropbox at the church. If blood is found, the next step is colonoscopy.
Doctors handed out kits in the parking lot during a drive-thru flu shot in October. Church members were required to watch and register a video about colon cancer in advance to ensure they were eligible for screening.
154 sets have been returned so far. Stacy Hill was one of 13 who tested positive. The 48-year-old Philadelphia woman had just lost her job and health insurance. Her colonoscopy revealed two growths that, like Abraham’s, were collected before they became cancer.
“I was shocked,” said Hill. “I am a proactive person so I was happy to know that.”
The doctors also helped her enroll in Medicaid, “so now I have health insurance,” and can continue to get cancer screenings, she said.
The Church hopes to resume home testing during blood pressure and diabetes studies this spring.
The Associated Press Department of Health and Science is supported by the Science Education Department of the Howard Hughes Medical Institute. The AP is solely responsible for all content.