Pandemic fears lead to worse outcomes for cancer patients
Chances of full recovery reduced by delaying screening or treatment
The COVID-19 pandemic is contributing to more serious outcomes for some breast cancer patients, the head of breast imaging at The Ottawa Hospital is warning.
Dr. Jean Seely said she sees the fallout on a weekly basis in the form of patients whose breast cancer has grown or spread while they waited for delayed treatments or avoided seeking medical attention because of fear of COVID-19. Some of them eventually go to the emergency department for help because they don't know where else to go, she said.
“We are seeing later-stage diagnoses because people are waiting. We are seeing larger tumours that are more likely to have spread to the lymph nodes,” said Seely, who is president of the Canadian Society of Breast Imaging.
“The chances of full recovery are significantly reduced the longer they wait,” she said. “Delaying a diagnosis of breast cancer for more than six months leads to loss of more lives to breast cancer.” There is a 98 per cent survival rate for localized breast cancer when it is detected early.
Patients have had both screening and surgeries delayed because of the pandemic. Renée Langman is among them.
The Embrun woman was scheduled to undergo surgery to remove a small cancerous tumour in her breast at The Ottawa Hospital on March 25. On March 23, after the province went into lockdown, she received a call telling her it was being postponed, like other surgeries across the province considered non-urgent.
She spent almost six weeks waiting and worrying.
Langman, who is 64, says she was terrified she would contract COVID-19 while she waited, which could delay things further. Finally, at the beginning of June, she received word that the surgery would go ahead on June 3.
By then, her tumour had nearly doubled in size from eight millimetres when she was diagnosed, to 15 millimetres.
Still, Langman considers herself lucky.
The cancer had not spread to her lymph nodes, which could mean lengthy chemotherapy and a more serious prognosis.
In addition to the surgery, she underwent 15 days of radiation and is taking tamoxifen, a hormonal therapy that blocks the effect of estrogen in breast tissue. In certain breast cancers, estrogen can promote cell growth.
Langman said the weeks of not knowing when she would have surgery were stressful and worrisome.
“It is one thing to live with cancer but another thing not knowing when they are going to do something for me.”
Her experience has underscored for her the importance of doing everything possible to catch breast cancer early. She encourages others who might have missed screening appointments during the pandemic not to wait.
That is the message the Canadian Society of Breast Imaging wants to get out as the pandemic continues.
“Cancer doesn't stop during COVID,” Seely said.
Some people, like Langman, had crucial treatments delayed during the pandemic as Ontario and other provinces shut down non-urgent surgeries to make room in hospitals for a possible surge of COVID-19 patients. Mammogram exams were also brought to a halt, causing thousands of women in the Ottawa region alone to miss routine screening, Seely said. Ontario recommends regular mammograms for all women starting at age 50, or earlier if they have risk factors.
But even with the resumption of mammogram screening, many patients are staying away, Seely said.
“Many people are almost stopping their lives and not doing some of the things that are so important for their health, and that includes screening for the investigation of cancer,” she said.
She said protocols are in place to ensure mammograms are safe.
“The world was not ready for the magnitude of this global health crisis. Fast forward six months later and we are in a much better position to deal with the situation,” she said.
Delays and cancellations caused by the pandemic have exacerbated problems that already existed in the system of diagnosing and treating breast and other cancers, she said. Those include chronically long wait times for MRIs and other medical imaging.
“Even before the pandemic outbreak, wait times for medical imaging in Canada far exceeded the acceptable 30-day standard.”
Seely said the consequences would be “dire” if medical imaging procedures were scaled back during a second wave of COVID-19.
Breast cancer is the second leading cause of cancer deaths among Canadian women. It is among numerous cancers for which diagnoses and some treatment have been delayed during the pandemic.