Zoey Agle
When the World Health Organization declared that COVID-19 was a pandemic in March of 2020, not only did cleaning supplies dwindle from grocery store shelves as Americans quarantined at home, but the rate of routine cancer screenings also dropped dramatically. People afraid to venture into medical establishments out of fear that they may be infected by the coronavirus, and many facilities that conduct screenings also closed their doors (Goshua 2020).
Research by the Epic Health Research Network found that in 2020, between March 15 and June 16, an estimated 285,000 breast, 95,000 colon, and 40,000 cervical cancer screenings were missed (Mast and del Rio 2020). With the number of COVID-19 cases falling and as vaccines are becoming more widespread, people are beginning to see their doctors and get screened for certain cancers again. However, the number of missed tests has created a backlog, meaning that screening appointments are often still being delayed (Goshua 2020).
Cancer screenings are important routine medical tests that occur before any symptoms indicating cancer may be felt. Who gets screened is decided by patients and their doctors based on recommendations regarding age and risk factors as set by the US Preventive Services Task Force. The screenings aim to find either precancerous lesions or early stage cancers, which are much easier to treat than later stage cancers (NCI 2021). An English study which found that diagnosing breast, colorectal, lung, ovarian, and prostate cancer before reaching stage 4 increases survival in the first year following diagnosis, with ovarian and lung cancer showing an increased 1-year survival rate with each earlier stage (McPhail et al. 2015).
Much of the benefit of cancer screenings is dependent upon testing early. Recent studies have already begun to show some negative impacts of delayed tests because of the COVID-19 pandemic. The University of Cincinnati Cancer Center found that once screening for lung cancer resumed at their testing site on June 1, 2020, 29% of individuals being screened were found to have lung nodules compared to 8% of individuals before the pandemic (NCI 2021). This may indicate that the longer time between screenings allowed for more nodules to develop. The increased number of nodules may be more dangerous and more difficult to treat than had fewer nodules been found earlier (NCI 2021). Mathematical modeling studies are also predicting increased deaths from cancer due to the delayed screening during the pandemic. For example, a study published in August of 2020 estimates that there will be over 3000 additional deaths from breast, colorectal, lung, and esophageal cancers combined in the United Kingdom (Maringe et al 2020). Experts predict that underserved communities, like communities of color, will be the most affected by the pandemic’s impact on screenings (Goshua 2020).
In addition to these negative health impacts, the delay of cancer screening caused by the COVID-19 pandemic presents interesting research opportunities that may ultimately have some positive outcomes. It would be unethical to purposefully delay cancer screenings for a cohort of individuals so the effect on their health could be studied. The pandemic, however, has created this scenario on a massive scale without the concern for ethics because it was not imposed by scientists. This now gives medical researchers the opportunity to determine how beneficial cancer screening is and the extent of the negative impact of overscreening. Overscreening includes screening individuals for a cancer to which they are not susceptible, like screening women who have had their uteruses and cervixes removed getting PAP smears; continuing to screen individuals for cancers once they have passed the recommended age range, which may lead to diagnoses in people who will die from other causes long before the cancer would impact them; and finding cancers that may have never impacted the patient's life, but end up getting treated by expensive and potentially harmful procedures (Zinberg 2016). The research opportunity that the pandemic has presented may provide data that can be used to hone the recommended age range for cancer screening. It may also provide information on how to quell overscreening, which may ultimately improve the lives of many patients who would have otherwise faced unnecessary tests, overdiagnosis, and superfluous treatments.
While the COVID-19 pandemic’s delay of cancer screenings will undoubtedly have a negative impact on the health of many individuals, researchers can ensure that some benefit still comes out of it. It has provided a rare chance to research the true implications of the routine screening programs in place which may allow for them to be improved to maximize their benefit and reduce any harm in the future.
References:
Goshua A. 2020. The Pandemic is Delaying Cancer Screening and Detection. Scientific
American [Internet]. [cited 2021 Apr 24]. Available from:
https://www.scientificamerican.com/article/the-pandemic-is-delaying-cancer-screenings-and-detection/
Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, Rachet B, Aggarwal A.
2020. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis
in England, UK: a national, population-based, modelling study. Lancet Oncol. 21:
1023-1034.
Mast C, del Rio AM. 2020. Delayed Cancer Screenings–A Second Look. Epic Health Research
Network [Internet]. [cited 2021 Apr 24]. Available from:
https://ehrn.org/articles/delayed-cancer-screenings-a-second-look
McPhail C, Johnson S, Greenberg D, Peake M, Rous B. 2015. Stage at diagnosis and early
mortality from cancer in England. British Journal of Cancer. 112: 108-115.
[NCI] National Cancer Institute. 2021. For Cancer Screening, COVID-19 Pandemic Creates
Obstacles, Opportunities. National Cancer Institute [Internet]. [cited 2021 Apr 24].
Available from: https://www.cancer.gov/news-events/cancer-currents-blog/2021/cancer-screening-decrea
es-coronavirus-pandemic
Zinberg J. 2016. Stop Overscreening for Cancer. City Journal [Internet]. [cited 2021 Spr 24].
Available from: https://www.city-journal.org/html/stop-overscreening-cancer-14335.html
Images:
The Noun Project [Internet]. 2020. Los Angeles (CA): The Noun Project Inc; [updated 2020 Sept
21; cited 2021 Apr 24]. Available from: https://thenounproject.com/
Research by the Epic Health Research Network found that in 2020, between March 15 and June 16, an estimated 285,000 breast, 95,000 colon, and 40,000 cervical cancer screenings were missed (Mast and del Rio 2020). With the number of COVID-19 cases falling and as vaccines are becoming more widespread, people are beginning to see their doctors and get screened for certain cancers again. However, the number of missed tests has created a backlog, meaning that screening appointments are often still being delayed (Goshua 2020).
Cancer screenings are important routine medical tests that occur before any symptoms indicating cancer may be felt. Who gets screened is decided by patients and their doctors based on recommendations regarding age and risk factors as set by the US Preventive Services Task Force. The screenings aim to find either precancerous lesions or early stage cancers, which are much easier to treat than later stage cancers (NCI 2021). An English study which found that diagnosing breast, colorectal, lung, ovarian, and prostate cancer before reaching stage 4 increases survival in the first year following diagnosis, with ovarian and lung cancer showing an increased 1-year survival rate with each earlier stage (McPhail et al. 2015).
Much of the benefit of cancer screenings is dependent upon testing early. Recent studies have already begun to show some negative impacts of delayed tests because of the COVID-19 pandemic. The University of Cincinnati Cancer Center found that once screening for lung cancer resumed at their testing site on June 1, 2020, 29% of individuals being screened were found to have lung nodules compared to 8% of individuals before the pandemic (NCI 2021). This may indicate that the longer time between screenings allowed for more nodules to develop. The increased number of nodules may be more dangerous and more difficult to treat than had fewer nodules been found earlier (NCI 2021). Mathematical modeling studies are also predicting increased deaths from cancer due to the delayed screening during the pandemic. For example, a study published in August of 2020 estimates that there will be over 3000 additional deaths from breast, colorectal, lung, and esophageal cancers combined in the United Kingdom (Maringe et al 2020). Experts predict that underserved communities, like communities of color, will be the most affected by the pandemic’s impact on screenings (Goshua 2020).
In addition to these negative health impacts, the delay of cancer screening caused by the COVID-19 pandemic presents interesting research opportunities that may ultimately have some positive outcomes. It would be unethical to purposefully delay cancer screenings for a cohort of individuals so the effect on their health could be studied. The pandemic, however, has created this scenario on a massive scale without the concern for ethics because it was not imposed by scientists. This now gives medical researchers the opportunity to determine how beneficial cancer screening is and the extent of the negative impact of overscreening. Overscreening includes screening individuals for a cancer to which they are not susceptible, like screening women who have had their uteruses and cervixes removed getting PAP smears; continuing to screen individuals for cancers once they have passed the recommended age range, which may lead to diagnoses in people who will die from other causes long before the cancer would impact them; and finding cancers that may have never impacted the patient's life, but end up getting treated by expensive and potentially harmful procedures (Zinberg 2016). The research opportunity that the pandemic has presented may provide data that can be used to hone the recommended age range for cancer screening. It may also provide information on how to quell overscreening, which may ultimately improve the lives of many patients who would have otherwise faced unnecessary tests, overdiagnosis, and superfluous treatments.
While the COVID-19 pandemic’s delay of cancer screenings will undoubtedly have a negative impact on the health of many individuals, researchers can ensure that some benefit still comes out of it. It has provided a rare chance to research the true implications of the routine screening programs in place which may allow for them to be improved to maximize their benefit and reduce any harm in the future.
References:
Goshua A. 2020. The Pandemic is Delaying Cancer Screening and Detection. Scientific
American [Internet]. [cited 2021 Apr 24]. Available from:
https://www.scientificamerican.com/article/the-pandemic-is-delaying-cancer-screenings-and-detection/
Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, Rachet B, Aggarwal A.
2020. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis
in England, UK: a national, population-based, modelling study. Lancet Oncol. 21:
1023-1034.
Mast C, del Rio AM. 2020. Delayed Cancer Screenings–A Second Look. Epic Health Research
Network [Internet]. [cited 2021 Apr 24]. Available from:
https://ehrn.org/articles/delayed-cancer-screenings-a-second-look
McPhail C, Johnson S, Greenberg D, Peake M, Rous B. 2015. Stage at diagnosis and early
mortality from cancer in England. British Journal of Cancer. 112: 108-115.
[NCI] National Cancer Institute. 2021. For Cancer Screening, COVID-19 Pandemic Creates
Obstacles, Opportunities. National Cancer Institute [Internet]. [cited 2021 Apr 24].
Available from: https://www.cancer.gov/news-events/cancer-currents-blog/2021/cancer-screening-decrea
es-coronavirus-pandemic
Zinberg J. 2016. Stop Overscreening for Cancer. City Journal [Internet]. [cited 2021 Spr 24].
Available from: https://www.city-journal.org/html/stop-overscreening-cancer-14335.html
Images:
The Noun Project [Internet]. 2020. Los Angeles (CA): The Noun Project Inc; [updated 2020 Sept
21; cited 2021 Apr 24]. Available from: https://thenounproject.com/
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