This may be another COVID-caused tragedy
When the initial COVID-19 outbreak was in full swing earlier this year, no one could have predicted the negative effects it would have on the country’s health, beyond even the illness and death it caused. One such effect has been a drop in cancer screenings in the state, which was especially true in the spring, when all but emergency medical procedures were put on hold. The data from that time period now shows how important screening is in the battle against cancer.
A research letter reported on in STAT noted a steep downward slope in six common types of cancer when they examined weekly numbers from Quest Diagnostics. When the data from January 2019 through February 2020 is compared to the data from the seven weeks from March 1 through April 18, 2020, the weekly number of newly diagnosed cancers fell 46.4 percent, combined, for the six most common cancers: breast, colorectal, lung, gastric, pancreatic and esophageal. The most dramatic drop was in newly diagnosed breast cancer cases.
“I was shocked by the figures,” said radiologist Anne Morris, MD, who works at Cuda Women’s Health Center in Hyannis. “Breast cancer dropped 52 percent.”
All doctors were following rules set by Governor Baker, she pointed out. In the beginning of the pandemic, the only patients who were receiving a workup were those who were symptomatic. Routine screening wasn’t allowed. But, even once things opened up and all routine imaging opened up, women were not coming in for mammograms – sometimes even after they had made an appointment to do so.
“On some days we’ve had as high as 30 percent of our patients who don’t show up,” Dr. Morris said. “I don’t know if it’s because they got cold feet or don’t feel safe, but I will tell you that I feel very safe at (Cuda). I would definitely say I’m more concerned about the grocery store.”
The staff has worked hard to make sure both patients and staff members are safe by instituting the following policies:
- All staff are required to "self-screen" each day prior to reporting to work. If they are experiencing any symptoms, they are to call their direct manager.
- All patients are screened for symptoms prior to and on the day of their appointment.
- All staff and patients are required to wear face coverings at all times.
- Patients are asked to sanitize their hands when they enter.
- Appointments are spaced out so that waiting rooms have fewer patients and staff have time to thoroughly clean the room.
- Chairs are spaced at least 6 feet apart.
- Patients are now given patient belonging bags that travel with them instead of utilizing lockers.
- Patients give their verbal consent in place of consent pad signature.
“I feel like the medical community in general, at Cape Cod Healthcare and throughout Massachusetts have been doing an excellent, excellent job,” Dr. Morris said. “People in healthcare really take this seriously.”
If patients still have lingering concerns, Dr. Morris recommends that they let the staff know and they will do everything they can to alleviate those concerns.
Even though it is extremely safe, Dr. Morris recommends that people with serious pre-existing conditions talk to their doctor about risk versus benefit. Certain high-risk patients need to be a little more cautious, but most patients should feel very safe coming in for their mammogram, she said.
Early Detection is Best
“The earlier we find a cancer the less aggressive the surgery and treatment is needed, so obviously the sooner the better, the smaller the better,” Dr. Morris said. “Breast cancer is one of those things that you want to catch while it is still in the breast. If you catch it when it is still in the breast it is very treatable, but once it has metastasized the prognosis is not as good.”
That said, Dr. Morris is not worried about any significant dangers in a six- or seven-month delay in screening because, for the most part, breast cancer grows slowly, with two exceptions. Triple negative breast cancer is more dangerous because it is a more aggressive cancer that lacks the receptors for estrogen, progesterone and the human epidermal growth factor protein called HER2. The absence of those hormones or the protein somewhat limits treatment options.
The other more dangerous cancer is inflammatory breast cancer, which is rare. It causes noticeable inflammation and redness of the skin. Those are noticeable symptoms that would have meant the patient was eligible for screening and treatment, even in the spring.
The recent lack of testing might temporarily skew the cancer numbers, but Dr. Morris points out that the incidence of cancer, overall, is not increasing.
“The cancer rate is the cancer rate,” she said. “As people return to screening, we will probably see an increase in the cancer rate. But the cancer rate hasn’t increased in general. We’re just delaying diagnosis. I think very few, if any, patients would be significantly harmed by a six-month delay.
A bigger danger is stretching it out longer, which people might inadvertently do if they missed getting their usual postcard reminder because the postcards didn’t get sent for several months. It’s easy to let six months turn into a much more dangerous lag in screening.
“We do want to encourage patients to come in because we don’t want a six-month delay to turn into a year to turn into a year and a half, Dr. Morris said. “Because we don’t know how long this pandemic is going to go on. We could still be in the same situation a year from now and we don’t want to be denying patients screening for a year or more.”