Cancer won’t wait for COVID-19

Cancer survivor shares her story around the importance of early diagnosis

In 2018, Adriana Ermter was diagnosed with early stage breast cancer. At only 47, Ermter had never been screened before, as most Canadian provinces do not recommend routine mammograms for women under 50. After discovering a lump, Ermter worked with her healthcare team to get the diagnostic tests she needed and start treatment before the cancer could spread.

An early diagnosis helped change the course of Ermter’s cancer journey. Today, the COVID-19 pandemic continues to impact cancer care for thousands of Canadians, changing how many patients interact with the healthcare system. With her treatment complete, Ermter is sharing her story to make sure others don’t let the pandemic stop them from having the best chance of a positive outcome.

“With any type of cancer, early diagnosis is key,” says Dr. Sandeep Sehdev, Medical Oncologist at the Ottawa Hospital Cancer Centre. “When cancer is caught early, a patient may have more treatment options, access to clinical trials and ultimately better survival rates.”

Before the pandemic, more than 225,000 people in Canada were expected to be diagnosed with cancer in 2020, but since the onset of COVID-19, diagnoses have fallen sharply. A recent survey of Canadian oncologists reports an estimated 16 per cent drop in newly diagnosed cancer patients over three months compared to 2019. It is estimated breast cancer diagnoses alone have gone down by nearly 20 per cent during the pandemic.

One reason for the drop in referrals and testing rates is a reluctance among patients experiencing cancer symptoms to see a doctor for fear of being exposed to the virus.

“We understand the anxiety people feel, whether they are living with cancer or pursuing a diagnosis. There’s a worry that they’re at higher risk and more vulnerable when it comes to COVID-19,” said Dr. Sehdev. “But fear of COVID exposure should not prevent people from seeking evaluation and care.”

A recent survey from the Canadian Cancer Survivor Network suggests some patients are hesitating to get in touch with their doctor because they’re not sure what services are available to them. Almost three-quarters of patients and pre-diagnosed patients also say they feel anxious about getting the care they need during the pandemic.

Even before COVID-19, Ermter said she faced hurdles in receiving a diagnosis. She understood the importance of identifying cancer and pursuing treatment as early as possible, and wants others in the same situation to not let COVID hold them back in getting the diagnosis and care they need.

“I was on assignment in Amman, Jordan, working as a reporter in one of the world’s largest refugee camps collecting stories for an international NGO when I found a lump in my right armpit. I was so far from home, there was honestly nothing I could do for a couple of weeks. So I filed it away, as something to be looked at later.”

Back home in Toronto, Ermter saw her doctor, who referred her to a breast cancer clinic. While she didn’t fit the profile for risk factors, she persisted.

“I didn’t meet the age requirement for a screening mammogram; I had no history of breast cancer in my family; I didn’t have any swelling or pain; I wasn’t a BRCA1 or BRCA2 gene carrier; and I had never tested positive for any other types of cancer. I was simply not seen as at risk for breast cancer.”

Ermter advocated for herself to get the tests she knew she needed, despite being perceived as low risk.

“I requested a mammogram. That testing determined that I had dense breasts, which meant I had to have additional testing with a MRI and ultrasound to confirm I had breast cancer, which I did as I suspected all along. Thankfully, it was still in the early stages.”

Ermter had a partial mastectomy in March 2018, one month after her diagnosis. While she has been in remission since then, she takes breast cancer medication daily and receives ongoing follow-up care every three to four months.

“When the pandemic started, I continued to have in-person appointments at the Princess Margaret Cancer Centre. The team there is fantastic, and fortunately, I did not experience any delays or interruptions in my care,” Ermter said.

“Our healthcare system and our healthcare professionals are under tremendous pressure with the pandemic,” said Cathy Ammendolea, Board Chair, Canadian Breast Cancer Network. “Thanks to their hard work and dedication to patients, cancer care services are still accessible in most regions. We want to encourage Canadians to get back to cancer care.”

New Normal, Same Cancer is an initiative from more than 25 Canadian healthcare organizations including the Canadian Breast Cancer Network, in partnership with AstraZeneca Canada. The campaign encourages Canadians living with cancer who have had their treatments paused, and those with possible cancer symptoms who have missed routine checks, to consult their healthcare teams without delay.

Ermter’s healthcare team, and many across the country, have also introduced virtual appointments to help ensure there are no disruptions to care.

“Virtual appointments can play a vital role when used in the right circumstances,” Dr. Sehdev explains. “They are ideal for discussions about results and talking about next steps. Right now, caregivers and relatives are not always able to attend inperson appointments, which can be difficult for patients who need that support. Virtual appointments with caregivers and relatives help fill that gap.”

Healthcare professionals are working hard to ensure the risk of COVID-19 exposure is minimized for patients in need of in-person care. Whether it is through virtual consultations or scheduling inperson appointments, those living with cancer or experiencing suspected cancer symptoms should contact their healthcare teams without delay.

“Cancer patients or those facing a diagnosis should feel re-assured about their safety,” Dr. Sehdev explains. “The biggest risk is in delaying their cancer care. If that requires going in to a hospital or clinic for tests or treatment, that should be their top priority.”

“When cancer is caught early, a patient may have more treatment options, access to clinical trials and ultimately better survival rates.”