John Abraham’s colonoscopy was delayed for several months because of the pandemic. When he finally succeeded, the doctors discovered a tumor that was too large to be safely removed during the scope examination. He had to wait several weeks for the surgery, then several more to find out that it had not yet become cancerous.
“I really wonder if I had been examined when I should have, if it would have been different” and the surgery could have been avoided, said Abraham, a mortgage banker in Peoria, Illinois.
Millions of colonoscopies, mammograms, lung scans, Pap smears and other cancer scans have been suspended for several months last spring in the United States and elsewhere, while COVID-19 overburdened medical care.
Now, researchers are studying the impact, looking to see how many cancers have been lost and whether the tumors found since then are more advanced.
There are already signs of problems. Researchers at the University of Cincinnati have discovered that when CT scans for lung cancer were resumed in June, 29% of patients had suspicious nodules versus 8% in previous years.
Several studies suggest that fewer cancers were diagnosed in the past year, probably because of fewer tests. About 75 cancer organizations recently called for a return to pre-pandemic screening levels as soon as possible.
But tumors take years to develop, and some reports suggest that the delay of a few months in screening for certain types of cancer may not have been as severe as was feared. For example, researchers in the Netherlands found that a lapse in that country’s mammography program did not lead to the detection of more cancers at a late stage after resumption of examinations.
The pandemic has also spawned some creative solutions, such as the wider use of tests that can be done at home. In Philadelphia, a large church has partnered with local doctors and used its drive-thru flu vaccination program to also distribute stool tests for colon cancer tests.
“We are not afraid to try anything when it comes to health and well-being,” said Rev. Leroy Miles of the Baptist Church of the Enon Tabernacle. “Women encouraged men to get tested, saying, ‘I did my mammogram’. And I’m saying, ‘Ma’am, you have two points, too.’ “
MERITS OF THE SCREENING
Screening tests differ in their risks and benefits, and health experts have long debated who should do which and how often. The pandemic lapse can serve as a “natural experiment” to see its value in modern times compared to what is known from studies done a long time ago.
Any difference in deaths can take years, and early detection is only one factor in survival. Treatment is also important and has been hampered by pandemic delays.
Dr. Ned Sharpless, director of the United States National Cancer Institute, estimates that there may be almost 10,000 excess deaths in the next decade because of the delay in the detection and treatment of breast and colon cancers. Postponing care “has been prudent in the past” because of the risks of exposure to COVID-19, but postponing it for a long time “can turn a public health crisis into many others,” he wrote in the journal Science.
Based on what is known about breast cancer deaths in recent years in the United States, about 10% “could have been prevented if women were undergoing routine tests”, but 20% to 25% could have been prevented with appropriate treatment, said Dr. Otis Brawley, a professor at Johns Hopkins University and former medical director of the American Cancer Society.
“This is not to say that screening is not important, but many people think that screening for cancer saves more lives than it actually does,” said Brawley.
A short-term delay may not do much harm to mortality if screening is resumed quickly, as is necessary, he said.
Some reassuring news came at a recent conference by the American Association for Cancer Research, by Sabine Siesling, of the Netherlands Comprehensive Cancer Organization. That country offers women aged 50 to 74 a mammogram every two years, but stopped in mid-March because of COVID-19. After it resumed in late summer, the results “showed no change” for more advanced tumors, she reported.
Researchers from Massachusetts General and Brigham and Women’s Hospital analyzed their screening tests for lung, cervical, colon, prostate and breast cancer. Screening dropped dramatically from March to June, but the portion that detected cancer or a pre-cancer was larger than normal, suggesting that those who were examined were at greater risk. When the screening returned to normal from June to September, the number of potentially “lost” cancers was less than expected.
BECOMING CREATIVE
When actor Chadwick Boseman, 43, died of colon cancer last summer, Miles feared for 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 locate and remove tumors 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 make people come if you are willing and able to organize something.”
Dr. Carmen Guerra had a federal grant to increase screening in communities with racial diversity and realized that home testing could help. Studies show that these tests, which look for blood in the stool, help save lives. People put a small sample of feces in a tube and send it to a laboratory or, in this case, use a collection box in the church. If blood is found, the next step is colonoscopy.
Doctors distributed kits in the parking lot during an influenza drive-thru event in October. Church members had to watch a colon cancer video in advance and register to ensure they were eligible for screening.
So far, 154 kits have been returned. Stacy Hill was among 13 with a positive test. The 48-year-old woman from Philadelphia had just lost her job and health insurance. His colonoscopy revealed two tumors that, like Abraham’s, were detected before they became cancerous.
“I was shocked,” said Hill. “I am a proactive person, so I was happy to know.”
Doctors also helped her sign up for Medicaid, “so I now have medical insurance” and I can continue to have cancer tests, she said.
The church hopes to offer testing at home again during blood pressure and diabetes testing events this spring.
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The Associated Press Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.