John Abraham’s colonoscopy was postponed for several months due to the pandemic. When he finally got it, doctors found that the growth was too large to safely remove during the bestie exam. He had to wait a few weeks for an operation, and then a few more to find out that it had not yet become cancerous.
“I absolutely wonder if I was screened when I should have done it, or if it would have been different,” and surgery could have been avoided, said Abraham, a mortgage banker in Peoria, Illinois.
Millions of colonoscopies, mammograms, lung scans, cardiac tests and other cancer examinations were suspended for several months in the United States and elsewhere this past spring because COVID-19 flooded medical care.
Now researchers are investigating the impact, to see how much cancer has been missed and whether tumors found since then are more advanced.
There are already hints of trouble. Researchers from the University of Cincinnati found that when CT scans to look at lung cancer again in June, 29% of patients had suspicious nodules compared to 8% in previous years.
Several studies suggest that fewer cancers were diagnosed last year, probably due to less screening. About 75 cancer organizations have recently insisted on a return to prepandemic screening levels as soon as possible.
But it takes years to develop tumors, and some reports suggest that the delay of a few months for certain types of cancer may not have been as severe as feared. Researchers in the Netherlands, for example, found that a decline in the country’s mammography program did not lead to more cancers being found at a late stage after screening resumed.
The pandemic has also shown creative solutions, such as a wider use of tests that can be done at home. In Philadelphia, a large church has partnered with local physicians and used its flu penetration program to also perform bowel cancer screening tests.
“We are not afraid to try something because it is related to health and wellness,” said Rev. Leroy Miles of Enon Tabernacle Baptist Church. The women encourage men to do the examination and say, ‘I got my mammogram. “And I say, ‘Ma’am, you have a colon too.’ ‘
EARNINGS ‘EARNINGS
Screening tests differ in their risks and benefits, and health experts have long debated who and what to get regularly. The decay of the pandemic can serve as a ‘natural experiment’ to see its value in modern times compared to what is known from studies done long ago.
Any difference in deaths can not be seen for years, and early detection is only one factor in survival. Treatment is also important and it is also harmed by pandemic delays.
Dr. Ned Sharpless, director of the U.S. National Cancer Institute, estimates that there could be nearly 10,000 excess deaths in the next decade due to the delayed detection and treatment of breast cancer and colon cancer. Postponement of care ‘was at one time’ sensible ‘because of the risks of exposure to COVID-19, but the postponement too long’ could turn one public health crisis into many others’, he wrote in the journal Science.
Based on what has been known about breast cancer deaths in recent years in the United States, about 10% “could be prevented if women were screened regularly,” but 20 to 25% could be prevented with the appropriate treatment, said Dr. Otis said. Brawley, a professor at Johns Hopkins University and former chief medical officer of the American Cancer Society.
“That does not mean that screening is not important, but many people think that cancer research saves more lives than it actually does,” Brawley said.
A short-term delay could not cause much damage to the deaths if the investigation had to resume quickly, he said.
Some reassuring news came at a recent American Association for Cancer Research Conference by Sabine Siesling of the Dutch Comprehensive Cancer Organization. That country offers women from 50 to 74 years old a mammogram every two years, but was discontinued in mid-March due to COVID-19. After resuming in late summer, the results ‘showed no shift’ to more advanced crops, she reports.
Researchers from Massachusetts General and Brigham and Women’s Hospital analyzed their screening tests for lung, cervical, colon, prostate and breast cancers. The investigation dropped dramatically from March to June, but the proportion who found cancer or a pre-cancer was higher than usual, indicating that those who were screened had a higher risk. When screening from June to September was almost normal again, the number of possible “missed” cancers was lower than expected.
BECOME CREATIVE
When 43-year-old actor Chadwick Boseman died last summer of colon cancer, Miles was afraid of the 12,000 members of his church in Philadelphia. 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 growth before it becomes cancerous.
Miles, who has drawn more than 1,000 congregation members to other health events, called the University of Pennsylvania and said, “We know how to get people to come if you are willing to set something up.”
Dr. Carmen Guerra had a federal grant to increase the performance in racial communities and realized that home testing could help. Studies show that these tests, which look for blood in the stool, help save lives. People place a small stool sample in a tube and send it to a laboratory or in this case use a subject cupboard at church. If blood is found, the next step is colonoscopy.
Doctors handed out kits in the parking lot during a door-to-door flu shot in October. Congregation members had to watch and register a video on colon cancer beforehand to ensure that they qualified for screening.
So far, 154 kits have been returned. Stacy Hill was among the 13 who tested positive. The 48-year-old woman from Philadelphia has just lost her job and health insurance. Her colonoscopy showed two growths that, like Abraham, were captured before it became cancerous.
“I was shocked,” Hill said. “I’m a proactive person, and I was glad to know that.”
The doctors also helped her enroll in Medicaid, ‘now I have medical insurance’ and I can still get cancer tests, she said.
The church hopes to offer home tests again during the spring during blood pressure and screenings for diabetes.
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