In an effort to curb the spread of COVID-19, many patients have delayed or skipped routine cancer screenings. Healthcare professionals are working to raise awareness around the potential consequences and educate patients in effective cancer prevention tactics.
As the latest wave of the coronavirus pandemic begins to ebb, a new clinical crisis may be preparing to rear its head. Patients hoping to reduce the spread of COVID-19 and ease the pressure on the healthcare system during the pandemic may have postponed routine cancer screenings over the last few years — which may lead to a surge in cancer diagnoses in the near future.
A dangerous domino effect
Fewer cancer screenings and biopsies have resulted in fewer surgeries, many of which have already been delayed. Preventative care services have also fallen significantly since 2020, according to a study published this past December in the journal Cancer.
Of particular concern is the decreased rate of colonoscopies, which dropped by nearly 50% in 2020 compared to 2019.1 Prostate biopsies were also down by more than 25%. New diagnoses declined between 13% and 23%, with percentages varying depending on the type of cancer, due to the decreased opportunity to detect cancers in routine screenings.
A research team with the American Cancer Society compared the number of real-time electronic pathology reports in 2020 and 2019, finding that a 10% decline in 2020 began soon after the start of the pandemic.
“We are seeing some improvements, but we still have a ways to go to get fully back on track,” said Marissa Fors, LCSW, OSW-C, C-ASWCM, CCM, director of specialized programs at CancerCare, a New York-based organization that provides free support services and information to help manage the emotional, practical, and financial challenges of cancer.
Related CE Course: Cancer in Women, 4th Edition
Shining a spotlight on mental health
Beyond the obvious ramifications of the pandemic, Fors notes additional challenges that healthcare professionals of all disciplines will face in the post-pandemic era. Keeping patients healthy will require attention not only to their physical health, but also their mental and psychological health.
Although mental health awareness has improved in recent years, the pandemic has created a new standard for vigilance.
“Mental health has been given its very deserving spotlight recently, but the pandemic has contributed to feelings of isolation, anxiety, and depression for many,” said Fors. “I hope to continue to see more patients pay attention to their mental health and have [healthcare professionals] follow that lead.”
Fors urges providers to remember that for some patients, even a routine cancer screening may inspire complicated feelings that must be navigated carefully. “One of the biggest challenges related to cancer prevention that [healthcare professionals] face is managing the anxiety that patients might experience when getting screened for cancer,” she said. “It is important to not dismiss these fears and to allow time to address them with your patients. When we acknowledge feelings and that experience, we are better able to understand and overcome these challenges and find solutions for our patients.”
Related CE Course: Management of Anxiety and Depression for Healthcare Professionals
Addressing risky behaviors
While its impact has been felt in virtually every corner of modern life, COVID-19 has not changed any of the traditional risk factors for cancer. Smoking, excessive alcohol consumption, a poor diet high in processed and red meats, sedentary lifestyles, and stress all continue to increase a patient’s risk for cancer.
But Fors believes healthcare professionals need to go beyond simple reminders. “People are at the most risk when they don’t have the information they need to make the best decisions for themselves,” she said. “And unhealthy habits form when we do not allow the space for our patients to speak up for themselves. Patients need to ask questions about their risks and their health. When patients are in a position to ask questions, they can better understand their health. There need to be more reminders to patients that they are not alone and that it’s ok to ask for help. There needs to be more attention [paid] to the underlying factors that contribute to [these risky] behaviors, and how we manage that is too often left out of the conversation.”
Screening programs
Developed in collaboration between CancerCare and the Community Oncology Alliance, a non-profit organization that advocates for community oncology practices, the Time To Screen program seeks to stem the tide of misinformation and promote healthy preventative practices among patients.
With the goal of increasing the rate of regular cancer screenings, the program informs patients about the availability of safe screening sites, which incorporate protocols that keep patients safe from COVID-19.
Fors says the program fosters some of the most important habits a patient can develop if they are going to maintain their overall health in the aftermath of the pandemic: self-advocacy and self-empowerment.
“These efforts will help patients feel more educated and empowered enough to continue their screenings safely and confidently,” said Fors. “This type of collaboration also encourages patients to take control of their health and to continue their regular cancer screenings. With these continued efforts, we will see even more improvements.”
General cancer screening tips
In general, all people at average risk should begin regular cancer screenings at age 25.
- Women should begin cervical cancer screening annually at age 25.
- Self-screening for melanoma should begin at the age of 25. Melanoma can appear anywhere on the body, even in areas that are not exposed to the sun; however, the most frequent locations for melanoma are the face, scalp, trunk or torso (chest, abdomen, back), legs, and arms.
- People between the ages of 25 and 65 should get a primary HPV (human papillomavirus) test performed every 5 years.
- Women ages 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
- Starting around the ages of 45 to 50, men should begin regular prostate cancer screenings.
- Colorectal cancer screening should begin at age 45 and continue through age 75.
References
- Englum BR, Prasad NK, Lake RE, et al. Impact of the COVID-19 pandemic on diagnosis of new cancers: A national multicenter study of the Veterans Affairs Healthcare System. Cancer. 2021. https://doi.org/10.1002/cncr.34011
- Yabroff KR, Wu X-C, Negoita S et al. Association of the COVID-19 pandemic with patterns of statewide cancer services. JNCI. 2021; djab122, https://doi.org/10.1093/jnci/djab122
