John Abraham’s colonoscopy was postponed for several months due to the pandemic. When he finally got it, doctors found it to be too big a growth to be safely removed during the scope examination. He had to wait a few weeks for surgery, and then several more to find out that he had not yet become cancerous.
“I absolutely wonder if they would have examined me when I was supposed to do it, if that had 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 screenings were suspended for several months last spring in the United States and elsewhere as COVID-19 flooded medical attention.
Researchers are now studying the impact and looking at 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 found that when computed tomography scans were resumed to check for lung cancer in June, 29% of patients had suspicious nodules compared to 8% in previous years.
Several studies suggest that fewer cancers were diagnosed last year, probably due to less screening. Recently, some 75 oncology organizations urged a return to pre-pandemic detection levels as soon as possible.
But tumors take years to develop and some reports suggest that a delay of a few months in detecting certain types of cancer may not have been as bad as feared. For example, researchers in the Netherlands found that a lapse in that country’s mammography program did not cause more cancers to be found at a late stage after resumption of screening.
The pandemic also spawned some creative solutions, such as a wider use of tests that can be done at home. In Philadelphia, a large church partnered with local doctors and used its flu vaccine program to also pass stool tests for colon cancer screening.
“We are not afraid to try anything related to health and well-being,” said Rev. Leroy Miles of the Baptist Church of the Enon Tabernacle. “The women encouraged the men to do the screening and they said, ‘They did the mammogram.’ And I say, ‘Ma’am, you have two points, too.’
MERITS OF THE SCREENING
Screening tests differ in their risks and benefits, and health experts have debated for a long time about who should get which ones and how often. The pandemic lapse can serve as a “natural experiment” to see its value in the modern era compared to what is known from studies done a long time ago.
No difference in deaths may be seen for years and early detection is only a survival factor. Treatment also matters and was also affected by the pandemic delays.
Dr. Ned Sharpless, director of the U.S. National Cancer Institute, estimates there would be nearly 10,000 excess deaths over the next decade due to delayed detection and treatment of breast and colon cancers. Postponing attention “was prudent at the same time” because of the risks of exposure to COVID-19, but postponing it too much “can turn a public health crisis into many others,” he wrote in the journal Science.
According to what is known about the deaths from breast cancer in recent years in the United States, about 10% “could have been prevented if women were subjected to routine screening,” but from 20% to 25% it could have been prevent with proper treatment, said Dr. Otis Brawley, a professor at Johns Hopkins University and a former chief physician of the American Cancer Society.
“That doesn’t mean screening isn’t important, but a lot of people think that cancer screening saves more lives than it actually does,” Brawley said.
A short-term delay may not do much harm to mortality if screening is resumed 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 Comprehensive Cancer Organization of the Netherlands. This country offers women aged 50 to 74 a mammogram every two years, but it stopped in mid-March due to COVID-19. After it resumed in late summer, the results “showed no change” toward more advanced tumors, he reported.
Researchers from Massachusetts General and Brigham and Women’s Hospital analyzed their screening tests for lung, cervical, colon, prostate and breast cancer. Screening was drastically reduced from March to June, but the part that found cancer or precancer rose from the usual, suggesting that those who were examined had a higher risk. When screening returned to normal from June to September, the number of potentially “lost” cancers was lower than expected.
CREATING
When actor Chadwick Boseman, 43, died of colon cancer last summer, Miles feared for the 12,000 members of his Philadelphia church. Blacks are more likely to die from the disease than other groups, and there was limited access to colonoscopies, 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 people come if you want and you can set something up.”
Dr. Carmen Guerra had a federal grant to increase screening in racially diverse communities and realized that home testing could help. Studies show that these tests, which look for blood in feces, help save lives. People put a small stool sample in a tube and mail it to a lab or, in this case, use a mailbox in the church. If blood is found, the next step is colonoscopy.
Doctors handed out kits in the parking lot during an anti-flu event in October. Church members had to watch a video about colon cancer in advance and register to make sure they qualified for control.
So far 154 kits have been returned. Stacy Hill was one of 13 who tested positive. The 48-year-old Philadelphia woman had just lost her job and health insurance. His colonoscopy revealed two growths that, like Abraham’s, were captured before they became cancerous.
“It surprised me,” Hill said. “I’m a proactive type person, so I was glad to hear that.”
Doctors have also helped him enroll in Medicaid, “so now I have health insurance” and I can continue to get tested for cancer, he said.
The church hopes to re-offer home testing during blood pressure and diabetes screening events this spring.
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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.