Vanderbilt-Ingram Cancer Center (VICC) doctors fear that drastic decreases in the use of recommended cancer screening tests during the COVID-19 pandemic could mean some early cancers have gone undetected. Before precarious health symptoms appear, screenings have the potential to detect precancerous lesions and cancers in initial stages, when they might be most treatable.
Indeed, the risks are worrisome for developing one of the three most common cancers, and those probabilities typically increase with age:
- Nonprofit BreastCancer.org statistics project one in eight U.S. women (about 13%) will develop invasive breast cancer over the course of her lifetime. In 2021, an estimated 281,550 new cases of invasive breast cancer are expected to be diagnosed in American women, along with 49,290 new cases of non-invasive (in situ) breast cancer.
- One in 16 people in America will be diagnosed with lung cancer in their lifetimes, according to LUNGevity Foundation research. More than 235,000 people in the U.S. are expected to be diagnosed with lung cancer during 2021, with a new diagnosis every 2.2 minutes.
- American Society of Clinical Oncology-related data estimates 149,500 U.S. adults will be diagnosed with colorectal cancer; this includes 104,270 cases of colon cancer (52,590 men/51,680 women) and 45,230 cases of rectal cancer (26,930 men/18,300 women).
"People are beginning to re-engage with the health care system, and we hoped to see a surge in health screenings sooner. We encourage everyone to get their screenings back on track. We know people are trying because we received more new cancer patients during March through April than any previous monthly records," says Laura Goff, MD, MSCI, executive medical director of the Vanderbilt-Ingram Cancer Center (VICC) Cancer Patient Care Center, 2220 Pierce Ave., in Nashville.
Dr. Goff knows firsthand how important screenings are because she cares for those who need active cancer treatments. She specializes in gastrointestinal cancer with a research focus on targeted drug development. One of her primary research interests is translating preclinical science into combination therapies for liver, gallbladder and bile duct cancers. Additionally, she directs medical care at the new VICC cancer clinic in Belle Meade.
The impact of the pandemic on overall cancer deaths will not be clear for many years, explains Eric Feuer, Ph.D., chief of the Statistical Research and Applications Branch in National Cancer Institute’s Division of Cancer Control and Population Sciences. “This is a complicated story that will reveal itself slowly over time,” he says.
“As we get a more complete picture of the pandemic’s impact on screening, then we can put the data in our models, and the models can estimate long-term outcomes from shorter-term data," he adds.
As a result of the coronavirus pandemic, Dr. Goff says an analysis by the Epic Health Research Network indicated diagnoses during January through April 2020, compared to typical years, for breast and cervical cancers dropped by 94% and for colon cancer decreased 86%—even though COVID-19 restrictions provided an opportunity to at least do home-based screening tests, such as the initial fecal immunochemical test (FIT) for colorectal cancer.
Dr. Goff says cancer patients are quite careful about all health aspects, and they understand the value of chemotherapy. "So, the pandemic really had more effect on those people who don't even know they have a problem yet. At the beginning of the pandemic, we thought it might be over in a matter of weeks, so if a person had no symptoms, it probably was OK to delay screenings for a month. Then, during last March, we got the sense the pandemic would last much longer, and we began to be concerned at the number of people not scheduling cancer screenings," she adds.
The U.S. Preventive Services Task Force officials recommend screening for four types of cancer—breast, colorectal, cervical and lung—among people of certain ages and with certain risk factors.
After a year of changes brought about by COVID-19, researchers are exploring ways to improve cancer screening during the current crisis and beyond. Dr. Goff says she and the VICC team learned much about what cancer-related circumstances and treatment support worked the best through telemedicine, with oral therapies being a prime example. "Chemotherapy holidays (deliberate breaks in using medications) are part of many cancer treatment regimens, and depending on comfort levels, we helped some of our patients schedule their chemo holidays during the early part of the pandemic," she adds.
Dr. Goff says she encourages anyone with a history of cancer to get vaccinated to ward off COVID-19. "These vaccinations are safe and could be important, especially if you need additional chemotherapy."
This medical oncologist reassures that health care professionals now know how to spot potential scan changes in mammograms due to recent vaccinations, and how to put those rare results into context.
One change in colorectal screenings noted by Dr. Goff is that Preventive Services Task Force officials lowered the recommended age to begin when people are 45 years old, instead of 50 years.
"We help with all cancer needs, and are proud to be leaders in cancer treatment for this region," says Dr. Goff.
VICC is one of 51 National Cancer Institute-designated Comprehensive Cancer Centers, dedicated to an integrated and patient-focused approach. The center is the only one in Tennessee that conducts research and cares for adults and children with cancer. They provide care for 7,000-plus new cancer patients – including more than 180,000 outpatient visits – each year. To schedule appointments there, call 615.258-6597 or visit MyHealthAtVanderbilt.com.
More people are in danger of dying from cancer due to lack of screenings during the COVID-19 pandemic. Medical teams stress it's vital to reinitiate regular screenings, especially colonoscopies, skin exams and mammograms. Because some cancers grow slowly, the pandemic's impact on overall cancer deaths won't be clear for years.