Pandemic Stops Cancer Screening: Consequences Coming?

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Last year, cancer screening programs around the world stopped as the rate of SARS-CoV-2 infection rose globally. The effect of this slowdown is now becoming clear.

Thousands of cancer diagnoses have “disappeared”, and oncologists are worried that this will lead to more advanced cancers and higher mortality in the years to come.

“I feel like this is an earthquake that has shaken our healthcare system. I guess you’ll probably still have repercussions on it over the next few years,” said Dr. Sharon Chang, a student surgical surgeon at Permanente Medical Group, Fremont, California.

She was the senior author of a study that analyzed the effects of slowing mammography as a result of a California “shelter in place” order on March 17, 2020. In the next two months, there were 64% fewer breast cancer diagnoses at 21 Kaiser Permanente Medical Centers compared to the same period 2019 . (250 vs 703).

In fact, approximately 450 breast cancer patients have “disappeared,” said co-author Dr. Annie Tang, a researcher at the University of California, San Francisco, East Bay Surgery Program.

“What surprised me the most from our data is the huge number of missing breast cancer patients,” Tang told Medscape Medical News.

A similar picture has emerged elsewhere.

In Boston, Massachusetts, it was estimated that 1,438 cancerous and precancerous lesions disappeared within the first 3 months of the pandemic’s exclusion, according to a study from the Massachusetts General Brigham Health System.

In this study, researchers assessed screening rates for five cancers – breast cancer (mammography), prostate cancer (prostate-specific antigen testing), colon cancer (colonoscopy), cervical cancer (Papanicolaou tests) and lung cancer (low-dose CT). )).

Screening rates during the first peak of the pandemic (March 2 to June 2, 2020) were compared with rates during the previous and next 3 months and during the same three months of 2019.

The results showed a marked decline in the screening rate during the peak of the pandemic compared to the three control periods. Reductions occurred for all screening tests and ranged from -60% to -82%.

There was also a significant reduction in the diagnosis of cancer as a result of a reduction in screening tests, ranging from -19% to -78%.

“Quantifying the real problem has made us realize how much work needs to be done to get back to prepandemic numbers,” said senior author Quoc-Dien Trinh, Ph.D. Med., FACS, co-director of Dana Farber / Brigham and Women’s Prostate Cancer Program.

In the Canadian province of Alberta, a similar decline in cancer diagnoses occurred during the early days of the pandemic.

By the end of 2020, Alberta was “missing” approximately 2,000 cases of invasive cancer and 1,000 cases of noninvasive cancer, Doug Stewart, senior medical director at the Alberta Health Service’s Strategic Clinical Network for Cancer (SCN), told. Medscape Medical News.

Stewart is able to track cancer diagnoses in Alberta almost in real time through a mandatory cancer registry. Within a month of exclusion, there was a 30% reduction in the diagnosis of invasive cancer and a 50% reduction in “the type of preinvasive cancer that is largely picked up by screening programs,” Stewart said.

After the health system reopened in the summer, Stewart said, the diagnosis of noninvasive cancer is still 20% lower than expected. A deficit of 10% has been reported in the diagnosis of invasive cancer.

The number of diagnoses has returned to normal by December 2020. However, Stewart is concerned that this fact hides a terrible truth.

He worries about backlogs. Although the number of diagnoses is now similar to what it was before the pandemic, “people show up later, and maybe the cancer is more advanced,” he speculated.

His team at Alberta Health Services is assessing whether cancers now being diagnosed are more advanced. Initial results are expected at the end of April 2021.

In the United Kingdom, there has been a similar halt in cancer screening as a result of the country’s closure. Researchers are now predicting an increase in cancer diagnoses.

Ajay Aggarwal, Ph.D. Med., A clinical oncologist advisor and associate professor at the London School of Hygiene and Tropical Medicine in London, United Kingdom, and colleagues estimated that at least 3,500 deaths from breast, colon, esophageal and lung cancer would occur during the summer. the next 5 years in England which could have been avoided had there been no measures to lock in the necessary pandemics.

I’m talking to Medscape Medical News, Aggarwal warned that these figures, derived from a modeling study published in August 2020, were “extremely conservative” because researchers took into account diagnostic delays in just a three-month period, the analysis included only four cancers and did not reflect treatment delay. cancer.

“I felt like it was the tip of the iceberg,” Aggarwal said. He warns that recent data suggests that “diagnostic delays are probably worse than we predicted.”

He suspects that there is more to the game than canceling the show.

In another study conducted in the United Kingdom, the data show a “drop in recommendations” from primary health care to cancer centers at the start of an early pandemic. In that study, researchers analyzed weekly hospital data from eight major UK hospitals in real time and found that emergency cancer recommendations fell to 70% at the lowest point.

“I was really surprised that the urgent recommendations dropped so drastically,” said the lead author, Dr. Alvina Lai, a lecturer in health data analytics at University College London.

She attributed this in part to patients’ compliance with the locking rules. “Patients try to follow government guidelines to stay at home and not go to it [general practitioners] unless necessary, “Lai explained in an interview with Medscape Medical News.

Canada, like the United Kingdom, has a publicly funded health care system. Stewart, of Cancer SCN in Alberta, came to a similar conclusion. “Some patients diagnosed with cancer … told me it took them an extra few months to even contact a family doctor because … they didn’t want to bother the family doctor with something other than COVID, that kind of guilt. They want to do something good for You know, most people are really very nice people and they don’t want to bother the health care system if they don’t have COVID, “Stewart said.

Shelley Fuld Nasso, executive director of the National Coalition for Cancer Survival, a nonprofit organization based in Silver Spring, Maryland, agreed that excluding screening is not the only danger. “While we agree that the examination is really important, we also want to make sure that patients follow their doctor regarding the symptoms they have,” she said.

“Some of the speculation or concern about increased cancer mortality is related to screening, but part is related to delayed diagnosis due to not following symptoms …. What worries me is not that everyone has that ability or willingness to advocate for themselves,” she said. .

Speaking at a press briefing held by the American Radiation Oncology Society on March 30, Nasso cited a case involving a patient who experienced severe pain in his arm. In a teleconsultation with his primary care physician he was diagnosed as arthritis. She was subsequently diagnosed with multiple myeloma in the emergency department.

Patients who “feel well” may delay their examinations to avoid going to the hospital and the risk of exposure to COVID-19.

“Some patients are still hesitant about returning for a mammogram or entering if they feel a lump in their breast,” Tang said. “That fear of COVID-19 still exists and we don’t know how long patients will delay.”

In London, Aggarwal saw a similar response to the pandemic. “People have quite significantly overestimated the risk of their death from acquiring COVID-19 and I think that balance has never been [redressed] explicitly, ”he said.

Public health initiatives to rebalance the exchange of messages are ongoing.

Public health in England and the National Health Service in England launched the “Help us help you” campaign in October 2020. The public information campaign invites people to talk to their doctors if they are “concerned about the symptoms that could be cancer”.

In Canada, the provincial government in Alberta has launched a public awareness campaign that conveys the message “cancer is not gone”.

“Cancer is still a major cause of potential lost years of life, despite COVID,” Stewart said. “We have to do everything in our power to make sure there is no slippage in survival rates.”

Tang, Chang, Lai, Stewart and Aggarwal did not disclose relevant financial relationships. Trinh received personal fees from Astellas, Bayer and Janssen and grants from Intuitive Surgical.

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