John Abraham’s colonoscopy was postponed for several months due to the pandemic. When he finally got it, the doctors found too much growth to be safely removed during the purpose examination. He had to wait a few weeks for surgery, then a few more to find out he hadn’t turned into cancer yet.
“I absolutely wonder if I would have been examined when it should have been, if it had been otherwise,” and surgery could have been avoided, said Abraham, a mortgage banker in Peoria, Illinois.
Millions of colonoscopies, mammograms, lung scans, Pap smears and other cancer screenings were suspended for several months last spring in the United States and elsewhere, while COVID-19 increased medical care.
Researchers are now studying the impact, looking to see how many cancers have been missed and whether the tumors found since then are more advanced.
Already, there are signs of problems. Researchers at the University of Cincinnati have discovered that when CT scans to check for lung cancer were resumed in June, 29% of patients had suspicious nodules, compared with 8% in previous years.
Several studies suggest that fewer cancers were diagnosed last year, probably due to lower screening. About 75 cancer organizations have recently called for a return to prepandemic screening levels as soon as possible.
But tumors take years to develop, and some reports suggest that a delay of several months in detecting certain cancers may not have been as bad as feared. For example, researchers in the Netherlands found that a deficiency in the mammography program in that country did not lead to the finding of more types of cancer at a later stage after resumption of screening.
The pandemic has also spawned several creative solutions, such as the wider use of home-based tests. In Philadelphia, a large church collaborated with local doctors and used its flu vaccination program to also pass stool tests for colon cancer screening.
“We are not afraid to try anything about health and wellness,” said Father Leroy Miles of the Enon Tabernacle Baptist Church. “Women encouraged men to get screened, saying, ‘I had a mammogram.’ And I say, “Ma’am, you have a colon, too.” ”
DESIGN MERITS
Screening tests differ in their risks and benefits, and health experts have long debated who should get which one and how often. The decline of the pandemic can serve as a “natural experiment” to see their value in modern times compared to what is known from studies long ago.
Any difference in deaths cannot be observed for years, and early detection is only a factor in survival. Treatment is also important and has also been affected by pandemic delays.
Dr. Ned Sharpless, director of the US National Cancer Institute, estimates that there could be nearly 10,000 excess deaths in the next decade due to delayed detection and treatment of breast and colon cancers. Postponing care “was prudent at one time” because of the risks of COVID-19 exposure, but postponing it for too long “could turn a public health crisis into more,” he wrote in the journal Science.
Based on what is known about breast cancer deaths in previous years in the United States, about 10% “could have been prevented if women had been routinely screened,” but 20% to 25% would have been could be prevented with proper treatment, said Dr. Brawley, a professor at Johns Hopkins University and a former chief medical officer of the American Cancer Society.
“That doesn’t mean screening isn’t important, but many people believe that cancer screening saves more lives than it actually does,” Brawley said.
A short-term delay can’t affect mortality much if screening resumes quickly, as it should, he said.
Some reassuring news came at a recent conference of the American Association for Cancer Research by Sabine Siesling of the Dutch Comprehensive Cancer Organization. This country offers women between the ages of 50 and 74 a mammogram every two years, but it stopped in mid-March due to COVID-19. After resuming in late summer, the results “showed no change” in more advanced tumors, she reported.
Researchers at Massachusetts General and Brigham and Women Hospital analyzed their screening tests for lung, cervical, colon, prostate and breast cancer. Screening dropped dramatically from March to June, but the part that found cancer or cancer was higher than usual, suggesting that those screened were at higher risk. When screening returned to normal from June to September, the number of potentially “missed” cancers was lower than expected.
BECOMING CREATIVE
When 43-year-old actor Chadwick Boseman died of colon cancer last summer, Miles feared the 12,000 members of his church in Philadelphia. Black people are more likely to die of the disease than other groups and there was limited access to colonoscopes, which can find and remove growths before they become cancerous.
Miles, who has attracted 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 arrange something.”
Dr. Carmen Guerra received 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 sample of stool in a tube and mail it to the lab or, in this case, use a box of drops at church. If blood is found, the next step is colonoscopy.
Doctors distributed kits in the parking lot during a flu vaccination event in October. Church members had to watch a video about colon cancer beforehand and register to make sure they qualified for screening.
So far, 154 kits have been returned. Stacy Hill was among the 13 who gave positive results. The 48-year-old Philadelphia woman had just lost her job and health insurance. Her colonoscopy revealed two growths that, like those of Abraham, were captured before they became cancerous.
“I was shocked,” Hill said. “I’m a proactive person, so I was glad to know.”
Doctors also helped her enroll in Medicaid, “so I have health insurance now,” and she may continue to receive cancer screenings, she said.
The church hopes to offer home tests again during blood pressure and diabetes screening events this spring.
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