Researchers study impact of pause of cancer screening in pandemic

John Abraham’s colonoscopy was postponed for several months because of the pandemic. When he finally got it, doctors found a growth too big to be removed safely during the scope exam. He had to wait several weeks for surgery, then several more to learn it had not yet turned cancerous.

“I absolutely wonder if I had gotten screened when I was supposed to have, if this would have been different” and surgery could have been avoided, said Abraham, a mortgage banker in Peoria, Ill.

Millions of colonoscopies, mammograms, lung scans, Pap tests and other cancer screenings were suspended for several months last spring in the United States and elsewhere as COVID-19 swamped medical care.

Now researchers are studying the impact, looking to see how many cancers were missed and whether tumors found since then are more advanced.

Hints of trouble

University of Cincinnati researchers found that when CT scans to check for lung cancer resumed in June, 29% of patients had suspicious nodules, versus 8% in prior years.

Multiple studies suggest that fewer cancers were diagnosed last year, likely because of less screening. About 75 cancer organizations recently urged a return to prepandemic screening levels as soon as safely possible.

But tumors take years to develop, and some reports suggest that a few months of delay in screening for 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 lead to more cancers being found at a late stage after screening resumed.

The pandemic also bred some creative solutions, such as wider use of tests that can be done at home. In Philadelphia, a large church partnered with local doctors and used its drivethru flu shot program to also pass out stool tests for colon-cancer screening.

“We’re not afraid to try anything as it relates to health and wellness,” said the Rev. Leroy Miles of Enon Tabernacle Baptist Church. “The women were encouraging men to get the screening, saying, ‘I got my mammogram.’ And I’m saying, ‘ma’am, you have a colon too.’”

Screening merits

Screening tests differ in their risks and benefits, and health experts have long debated whom should get which ones and how often. The pandemic lapse may serve as a “natural experiment” to see their value in modern times, versus what is known from studies done long ago.

Any difference in deaths may not be seen for years, and early detection is only one factor in survival. Treatment also matters, and it was hurt by pandemic delays, too.

Dr. Ned Sharpless, director of the U.S. National Cancer Institute, estimates there could be nearly 10,000 excess deaths over the next decade because of delayed detection and treatment of breast and colon cancers. Postponing care “was prudent at one time” because of the risks of COVID-19 exposure, but deferring for too long “may turn one public health crisis into many others,” he wrote in the journal Science.

Based on what is known about breast-cancer deaths from past years in the United States, about 10% “could have been prevented if women were getting routine screening,” but 20% to 25% could have been prevented with appropriate treatment, said Dr. Otis Brawley, a Johns Hopkins University professor and former chief medical officer of the American Cancer Society.