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The effect of the pandemic cancer screening delay is being examined by researchers.

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The effect of the pandemic cancer screening delay is being examined by researchers.
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The effect of the pandemic cancer screening delay is being examined by researchers.

The effect of the pandemic cancer screening delay is being examined by researchers.

 

Because of the pandemic, John Abraham’s colonoscopy was postponed for several months. When he eventually received it, doctors discovered a growth that was too large to be safely removed during the scope exam. He had to wait a few weeks for surgery, then another few weeks to find out it hadn’t become cancerous.

“I absolutely wonder if I had gotten tested when I was supposed to have,” Abraham, a mortgage banker in Peoria, Illinois, said, “if this would have been different” and surgery might have been prevented.

As COVID-19 wreaked havoc on medical care in the United States and elsewhere last spring, millions of colonoscopies, mammograms, lung scans, Pap tests, and other cancer screenings were halted for several months.

Researchers are now examining the effect, attempting to determine how many cancers were overlooked and whether tumors detected since then have progressed.

There are already signs of trouble. When CT scans to screen for lung cancer were resumed in June, 29 percent of patients had suspected nodules, compared to just 8% in previous years, according to University of Cincinnati researchers.

According to multiple surveys, less cancers were detected last year, owing to less screenings. Approximately 75 cancer groups have called for a return to prepandemic screening levels as soon as it is safe to do so.

However, tumors take years to form, and some studies indicate that a few months’ delay in cancer screening might not have been as detrimental as previously believed. Researchers in the Netherlands, for example, discovered that a lapse in the country’s mammography program did not result in further cancers being discovered at a late stage until screening was reinstated.

The pandemic also spawned several innovative solutions, such as expanding the use of at-home studies. In Philadelphia, a major church collaborated with local physicians to provide stool tests for colon cancer screening as part of its drive-thru flu shot program.

The Rev. Leroy Miles of Enon Tabernacle Baptist Church said, “We’re not afraid to try something when it comes to health and wellness.” “The women were urging men to get screened by saying things like, ‘I had my mammogram.’ And I’m telling her, ‘Ma’am, you, too, have a colon.’

THE BENEFITS OF SCREENING

The risks and benefits of screening tests vary, and health experts have long discussed who should get which tests and how often. The pandemic pause may be used as a “natural experiment” to compare their importance in modern times to what has been learned from previous studies.

Any change in death rates may take years to notice, and early detection is just one factor in survival. Treatment is also essential, and pandemic delays harmed it.

According to Dr. Ned Sharpless, director of the National Cancer Institute in the United States, delayed diagnosis and treatment of breast and colon cancers could result in nearly 10,000 additional deaths over the next decade. Because of the risks of COVID-19 exposure, deferring treatment “was wise at one time,” but doing so for too long “may transform one public health issue into several more,” he wrote in the journal Science.

According to Dr. Otis Brawley, a Johns Hopkins University professor and former chief medical officer of the American Cancer Society, about 10% of breast cancer deaths in the United States may have been avoided if women had received routine screening, but 20% to 25% could have been prevented with proper care.

“That’s not to say screening isn’t important,” Brawley said, “but many people believe cancer screening saves more lives than it actually does.”

If screening resumes rapidly, as it must, a short-term delay does not have a significant impact on mortality, he said.

Sabine Siesling of the Netherlands Comprehensive Cancer Organization provided some reassuring news at a recent American Association for Cancer Research conference. Because of COVID-19, the country no longer offers mammograms to women aged 50 to 74 every two years. She confirmed that after it was restarted in late summer, the findings “did not indicate any shift” to more advanced tumors.

Researchers from Massachusetts General Hospital and Brigham and Women’s Hospital examined their lung, cervical, colon, prostate, and breast cancer screening examinations. From March to June, the number of people who got screened fell significantly, but the number of people who got cancer or a precancer was higher than average, meaning that those who did get screened were at higher risk. From June to September, when screening returned to near-normal, the number of potentially “missed” cancers was lower than predicted.

IMPROVING YOUR CREATIVITY

Miles was concerned for the 12,000 members of his Philadelphia church when 43-year-old actor Chadwick Boseman died of colon cancer last summer. Black people are more likely than other races to die of the disease, and colonoscopies, which can detect and extract growths until they become cancerous, were scarce.

Miles, who has attracted over 1,000 church members to other health activities, called the University of Pennsylvania and said, “If you’re willing and able to set anything up, we know how to get people to come.”

Dr. Carmen Guerra obtained a federal grant to improve screening in racially diverse neighborhoods, and she discovered that home tests could help. These tests, which check for blood in the stool, have been shown in studies to save lives. People put a small stool sample in a tube and mail it to a lab or use a drop box at the church, as in this case. If blood is discovered, a colonoscopy is performed.

During a drive-thru flu shot case in October, doctors distributed kits in the parking lot. To be considered for screening, church members had to watch a video about colon cancer and register in advance.

154 kits have been returned so far. One of the 13 people who tested positive was Stacy Hill. The Philadelphia woman, 48, had recently lost her work and health insurance. Her colonoscopy revealed two benign tumors, which, like Abraham’s, were discovered before they became cancerous.

“I was taken aback,” Hill said. “I’m a proactive person, so I was relieved to learn.”

The doctors also assisted her in enrolling in Medicaid, “so now I have medical insurance” and can continue to receive cancer screenings, she explained.

During blood pressure and diabetes screening events this spring, the church hopes to offer the home tests once more.

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