And some tests, such as those for prostate cancer, are harder to track using medical records because of how they are coded. One major issue, Knudsen says, is that people who miss screenings aren’t always flagged for follow-up. Velazquez et al., in JAMA Network Open Aug( data) We don’t know the impact of this yet, but it’s definitely a problem.”Ĭredit: Jen Christiansen Source: “Trends in Breast Cancer Screening in a Safety-Net Hospital during the COVID-19 Pandemic,” by Hana I. “We’ve made progress getting people back in the door, but there’s a large population that is underscreened. Knudsen, chief executive officer of the American Cancer Society. “Between the peaks, what we didn’t see was sufficient recovery,” says Karen E. Those who never rescheduled may be up to two years behind. Screening rates synchronized with pandemic waves, bouncing back in the summer of 2020 before falling during subsequent surges. Similar drop-offs were seen across the country, where in some cases up to 95 percent of colonoscopies were missed in the first months of the pandemic. Choueiri’s health system usually performs more than 9,000 colonoscopies in any three-month period in March, April and May of last year, there were just over 1,700 in total. This was especially true for colonoscopies, the most invasive screening and an exam that many avoided even before the pandemic. and the world, rates of those routine screenings fell precipitously. Yet as the pandemic spread throughout the U.S. Screening tests such as Pap smears, mammograms, colonoscopies, lung scans and prostate-specific antigen tests clearly save lives: although rates vary by cancer type, five-year survival is consistently higher when the disease is caught in its early stages. “I hope my experience is a reminder for everyone of the value of routine health checkups, exams and follow-through,” she wrote in a recent blog post.Ĭancer kills some 600,000 people in the U.S. With surgery and radiation completed and a good prognosis in hand, Klobuchar is urging others not to put off their screenings. After delaying the procedure, she had a routine mammogram in February 2021. One patient whose pandemic screening turned up early-stage breast cancer was Senator Amy Klobuchar of Minnesota. But because both the disease and its epidemiology are so complex, those results may take years, or even decades, to become clear. COVID may prove to be a grand experiment assessing the import of cancer screening, and results are beginning to trickle in. But as more time passed and screenings resumed, the outlook grew less dire. As the pandemic wore on, some cancer centers began to report a worrisome increase in advanced cancer diagnoses. Screenings for some cancers fell by 90 percent when COVID struck, making a postpandemic surge of cancer deaths seem a foregone conclusion. In those early days National Cancer Institute officials estimated the pandemic would result in 10,000 excess cancer deaths in breast and colon cancer alone over the coming decade. More than 60,000 patients are typically screened there for cancer in a three-month period in the first three months of the pandemic, he says, fewer than 16,000 came in for tests. Their study, published in JAMA Oncology in January 2021, showed a steep drop in screening from March to June of 2020 in his health system, Massachusetts General Brigham. He envisioned a future with streams of patients who had cancers so advanced he could no longer cure them.ĭriven by these concerns and a desire to know exactly how bad the problem was, Choueiri and his colleagues turned to the data. He worried about tumors seeding, taking hold, growing and metastasizing without being detected. The veteran oncologist feared that the lack of screenings, which aim to detect cancer at its earliest stages, would lead to a tidal wave of missed diagnoses. As COVID cases surged frighteningly across the country, cancer detection seemed to be the last thing on anyone’s mind.Ĭhoueiri, who directs the Lank Center for Genitourinary Oncology at the Dana-Farber Cancer Institute, saw a steep drop in new consultations in the pandemic’s early months. Hospital administrators struggled to find enough PPE to take care of urgent surgeries, and elective procedures fell to the wayside. Hospital corridors quieted screening center workers were sent home. Screening center schedules, once full of mammography appointments, cleared dramatically. In Boston-and around the nation-colonoscopy suites stood empty as patients refused to come in, terrified of setting foot in any hospital or clinic. He was concerned not only about the rapid rise in COVID infections but about the swift shutdown in cancer screenings. As the novel coronavirus swept through Boston last March, Toni Choueiri was worried.
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