Several sets of data presented at the meeting suggest that delays in breast cancer, prostate cancer, and colon cancer screening, as well as other forms of cancer screening, could result in later diagnoses and worse outcomes for some patients. “In terms of new diagnoses, a delay of a few months shouldn’t be a huge problem for most people, as long as those individuals are coming back and getting screened,” said Mara Epstein, a doctor of science in epidemiology and an assistant professor of medicine at the Meyers Primary Care Institute at University of Massachusetts Medical School in Worcester, who presented data at the conference. “A larger, negative impact on patient outcomes could happen if people are canceling these appointments and never getting screened, or if they are waiting a year or two to come back,” says Dr. Epstein. “If people don’t get screened, they might miss the chance to catch a cancer at an early stage, when they might have a better prognosis.” RELATED: Cancer Experts Express Concern About How COVID-19 Is Impacting People With Cancer
A Steady Decline in Screening Since April
In her study, Epstein and her colleagues looked at breast and prostate cancer screenings and early detection in a large healthcare provider group in Massachusetts, a state that was heavily impacted by the pandemic in the months of April and May. They analyzed data recorded in 2019 of 65,312 men and 80,629 women and 2020 data of 66,396 men and 82,695 women. When comparing the two time periods, the researchers found that the monthly number of mammograms fell significantly between the first five months of 2019 compared with the first five months of 2020 — from 13.6 mammograms per 1,000 women per month to 0.25 per 1,000 in April 2020 and 1.1 per 1,000 in May 2020. Rates of digital breast tomosynthesis, or 3D mammography, another form of screening, also fell dramatically in 2020 compared with 2019. The study found the level of decline was greatest among women ages 75 to 85. The study also showed declines in prostate specific antigen (PSA) testing for prostate cancer in men, although not as severe as the decline seen in breast cancer screening. PSA testing rates in 2019 were 34.4 per 1,000 per month compared with 17.6 per 1,000 per month in March 2020. In a similar study presented at the AACR meeting, researchers at Massachusetts General Hospital in Boston surveyed 404 women, most of whom were ages 50 to 69, regarding breast cancer screening during the COVID-19 pandemic months. More than one-quarter of the participants said they delayed or canceled breast cancer care during the pandemic. Most of the delays or postponements involved breast cancer screening. While many delays and cancelations were initiated by patients, some were because of recommendations. In March, the National Comprehensive Cancer Network, a not-for-profit alliance of 30 leading cancer centers, recommended postponing screenings, and many institutions followed that recommendation. Many healthcare centers also put cancer screenings on hold to prioritize resources for urgent medical needs related to the pandemic, according to the American Cancer Society (ACS). Those screenings now are being scheduled again in many places. RELATED: COVID-19 Deadly for Patients Whose Cancer Is Progressing
How to Make Decisions About Cancer Screening Going Forward
Patients and their doctors should discuss the pros and cons of delaying cancer screenings more than a few months, Epstein suggests. The pandemic will likely be with us for at least a year, Epstein says. “The potential problem is that we don’t know when COVID rates will be under control, and if they will rebound in the fall or winter, potentially delaying these tests even more. We don’t want people delaying their screening tests indefinitely,” she says, “so it’s an important conversation to have with your healthcare provider.” Some of the advice may depend on the numbers where you live. “If you live in a hot spot, or an area with an increasing number of [COVID-19] cases, then maybe you want to postpone your screening test until COVID is more controlled where you live,” she says. Certain high-risk populations, such as those who carry a known cancer mutation that elevates risk, for instance, may benefit from having the screening test sooner rather than later, says Epstein. The ACS advises people to speak with their healthcare provider about when to reschedule or schedule a cancer screening. They also note that screening recommendations are general and are intended for large groups of people. There may be some flexibility in some tests. For example, people who require colorectal cancer screening who are at average risk for the disease may be able to opt for a home stool test — called fecal immunochemical testing. If the test is positive, a colonoscopy may be required. Both healthcare providers and patients should assume responsibility for maintaining a sensible cancer-screening regimen, Epstein says. “Providers will have to contact their patients who missed or postponed screening tests to encourage them to reschedule their appointment,” she says. “I think it is also the responsibility of patients to reschedule those appointments. The most important issue is to make sure patients aren’t falling through the cracks — we don’t want patients to just cancel their screening test and never come back.”
