Sharp Declines in Routine Health Screenings during Pandemic

The disruptions of the initial lockdown in the spring of 2020 in response to the COVID-19 pandemic caused routine screenings for breast and colorectal cancer to decline by over 90% in one study of people ages 46 to 64.

In the Medicare population aged 65 or older, screenings for breast cancer declined by 85%, colorectal cancer by 75%, prostate cancer by 74%, and lung cancer by 56%. The pandemic had widespread effects on screening rates globally as well.

These declines in screening were caused by many factors, such as orders to stay home and restrict activity, reduced media outreach by hospitals, rescheduled appointments, limited primary care appointments for referrals, and individual concerns about exposure. Collectively, these factors caused delays in diagnosis and a poorer prognosis, and a projected increase in excess deaths over the longer term.

Although one study found that screenings rebounded to pre-pandemic rates by July 2020, catch-up screening requires above-normal uptake than the pre-pandemic norm. Unfortunately, higher risk individuals may have been even less likely to get back on track when lockdowns were eased. Compounding this challenge, staffing issues during subsequent waves of SARS-CoV-2 infection made it difficult to increase capacity in order to make up for the lockdown-associated decline.

It is likely that those most affected by COVID concerns—such as those with high-risk health conditions—have fallen behind on necessary routine care. Inequities in access to care, such as caused by poverty or living in a rural area, may have also made it more challenging for many people to get back on track. Collective awareness and mutual support will be required to get the screening rates back to normal.

What can be done to increase cancer screenings?

The strategies employed to boost screening must respond to the unique needs of the population being served. In areas with the resources for screening, people may have concerns about how to access care while in areas with fewer resources the primary challenge may be awareness of the benefits of screening. Outbound phone calls and reminder programs can help bring patients back in for care. Governments could also consider cash payments or improved medical coverage to reduce or eliminate out-of-pocket costs for screening.

Telehealth services can also be more widely utilized to help those with a cancer diagnosis manage their care and increase uptake of screening appointments by providing a personal connection to the clinic. It is even possible to provide non-invasive screening test kits, such as stool (fecal) tests or DNA testing. Medical practices should consider their patient population and the unique barriers to care when designing outreach activities.

Breast cancer screening tests

The current breast cancer screening recommendation from the US Preventive Services Task Force (USPSTF) is annual screening for women ages 50 to 74 years who are at average risk. Women who are ages 40 to 49 should discuss the risks and benefits of screening with their doctor based on personal risks and family history.

The tests used include a mammogram which is an X-ray of the breast and breast magnetic resonance imaging (MRI). Breast MRI is used for women who are at higher risk of breast cancer, but because it is so sensitive, certain abnormalities may be detected which are not actually cancerous.

Shifting breast cancer screening guidelines

Of note, there has been some controversy over the years as breast cancer screening guidelines have changed to better balance the risks and benefits of screening. Mammograms do pose some small risk of radiation due to repeated X-rays and can miss some cancers (false negative results). On the other hand, high-sensitivity tests can lead to false positives and over-diagnosis, resulting in unnecessary treatment or surgery. Generally, the various organizations which have reviewed the evidence suggest individual choice in consultation with the woman’s physician between ages 40 to 49, with routine screening starting at age 50.

Who is at highest risk for developing breast cancer?

Breast cancer is the second most common cancer among women in the US. Media campaigns can help increase awareness of the need for cancer screening, but a surge in demand can stress the capacity causing long wait times. Awareness campaigns can provide specific information to certain groups who may be at higher risk, such as women with dense breast tissue, a family history of breast cancer, or a genetic risk (BRCA1 or BRCA2).

What tests are available for colon cancer?

Colon cancer is the fourth most common cancer among men and women in the US. It is also the fourth leading cause of cancer death in the US. The current recommendation for colon cancer screening is ages 45 to 75. People older than 75 can make a decision in conjunction with their doctor about the best testing regimen.

Personal and family history of colorectal cancer influence the frequency and type of screening test you should get. The CDC recommends annual testing using a fecal sample or colonoscopy every 5 to 10 years, depending on the findings and your risk profile. The likelihood that you will follow through with a screening test also matters—if you know that you’re unlikely to get a colonoscopy, then you should at least get a stool test. The USPSTF provides a helpful guide on the tests: guaiac-based fecal occult blood test (gFOBT) or fecal immunochemical test (FIT).

While colonoscopy is the gold standard, many people are deterred by the preparation required, which includes bowel cleansing. However, mindset is important—bowel cleansing could also be one step on a path to breaking certain dietary habits and establishing a fresh start.

Risk factors for colorectal cancer

If you have any of these risk factors for colorectal cancer, consider scheduling your colonoscopy today: inflammatory bowel disease, a family history of colorectal polyps or a genetic predisposition, exercising too little, eating too few fruits and vegetables, a high-fat/low-fiber diet, eating processed meats, being overweight or obese, and alcohol and tobacco use.

Being aware of which tests are recommended is the first step, and making a plan to get screened is the next most important step. For readers who are age 50 or more, consider scheduling your breast and colorectal cancer screening test today. Consider finding a buddy to get tested on the same day and hold each other accountable. This might make an otherwise unpleasant or onerous task a little more enjoyable.


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