Story at a glance

  • According to the Cancer Network, there was an 89.2% drop of breast cancer screenings, and an 84.5% drop in colorectal screenings through May 2020.
  • This is because of clinics closing during lockdowns, dispersion of medical staff, fear-based patient reluctance, and the inability of patients to provide payment due to losing their job(s).
  • Experts warn that the decline in screenings makes way for the discovery of cancers in advanced stages.
  • Investigators estimate a 7.9% increase in deaths from breast cancer up to 5 years from diagnosis, 15.5%-16.6% increase in colorectal cancer deaths, and a 4.8%-5.3% increase in lung cancer deaths.

In the Cancer Network’s Oncology Journal, an open letter was written for the readers. The letter, titled “Delay in Cancer Screening and Diagnosis During the COVID-19 Pandemic: What is the Cost?”, came from the voice of Julie M. Vose, MD, MBA, who is the Chief of Hematology/Oncology at University of Nebraska Medical Center.

She observed that standard cancer screenings, such as breast and colorectal cancer screenings dropped significantly through May 2020, at the height of the pandemic.

  • Breast cancer screenings dropped by 89.2%
  • Colorectal cancer screenings dropped by 84.5%

Her letter also notes that new diagnoses of cancer have dropped and that this “will potentially increase the number of patients with later-stage cancers leading to decreased survival for these patients.” (1).

  • New diagnosis of melanoma dropped by 67.1% in April 2020 (compared to 2019 data)
  • New diagnosis of lung cancer dropped by 46.8% over the same amount of time

Reasons for decreased cancer screening

The decreasing percentages of cancer screenings is potentially linked to the pandemic control efforts. At the start of the pandemic (April and May 2020), society saw business closures and deferred care in attempt to ‘slow the spread’. This led to job losses, misdiagnoses, or undiagnosed conditions.

In an article published in the New York Times, Yvette Lowery (a South Carolina resident), recalled when her annual mammogram was cancelled in March 2020 as medical facilities began to shut down at the start of the pandemic.

In August 2020, Lowery felt a lump under her arm but could not get a scheduled appointment until October 2020. Eventually, she was diagnosed with Stage 2 breast cancer, and needed chemotherapy along with a double mastectomy.

One of her doctors stated that had Lowery’s cancer been detected in May 2020, it would have not had the opportunity to spread.

Why did cancer screening percentages drop?

  • The general public could not afford to pay for cancer screenings out of pocket, as countless people had lost their jobs.
  • Lockdowns required medical facilities to close or have limited hours. This meant that some people’s appointments were continuously deferred.
  • Some health professionals depended on ‘telemedicine’ to diagnose patients. This is problematic because not all symptoms can be visible or understood clearly through the phone/video chat. Not only could this lead to an understatement of care, but it could also lead to dangerous misdiagnoses.
  • Health officials were dispersed to assist in the testing/treating of COVID-19. This meant that local health facilities lost support.
  • Fear-based reluctance from patients caused them to be uncomfortable with attending a healthcare facility. They associated healthcare facilities with contracting COVID-19.

With less cancer screening, the potential for malignancies to be diagnosed at a later stage becomes relevant. Julie M. Vose, MD, MBA, says that “this could translate into worse outcomes when patients are diagnosed later in the course of the disease making treatment more difficult and the cancer less able to be cured.” (2)

Investigators estimate a 7.9% increase in deaths from breast cancer up to 5 years from diagnosis, 15.5%-16.6% increase in colorectal cancer deaths, and a 4.8%-5.3% increase in lung cancer deaths.

Officials’ efforts to ‘slow the spread’ and save lives through government-mandated lockdowns may have unironically caused more harm than intended. Impulsive measures were enforced, without considering the long-term effects.

Further Discussion

References