A new study found that late-stage diagnoses for breast and colorectal cancer are increasing while early-stage diagnoses are decreasing—and that the trend could be an indirect result of the COVID-19 pandemic.
The study, published last week in JAMA Network Open, involved data from 522 people who visited the Moores Cancer Center at University of California San Diego Health in 2019 and 2020. While the total number of cancer diagnoses were similar in both years, there were more late-stage diagnoses in 2020, after the emergence of COVID-19.
In 2019, nearly 64% of new breast cancer diagnoses were stage 1, and less than 2% of diagnoses were stage 4. But in 2020 after the start of the COVID-19 pandemic, just 51% of all new breast cancer diagnoses were stage 1, while the amount of late-stage diagnoses rose to 6.2%.
A similar—though less severe—trend was seen in colorectal cancer diagnoses: In 2019 versus 2020, stage 1 colorectal cancer diagnoses decreased from 17.8% to 14.6%, while stage 4 diagnoses jumped from 6.7% to 19.5%.
Study authors believe the increase in late-stage diagnoses may be linked to lockdowns during the COVID-19 pandemic. "Our study was only designed to look at the numbers of diagnoses and stage at diagnosis so we don't know for sure why we are seeing the trends that we see. But my concern is that people may have been delaying routine medical care during the pandemic," study co-author Kathryn Gold, MD, a medical oncologist at UC San Diego Health, tells Health. "People may have put off cancer screenings like mammograms and colonoscopies because they were concerned about exposure to COVID-19. The late stage cancers that we're seeing now might have been picked up at an earlier stage if screening had been performed."
How relaxed screening protocols during the pandemic are showing up in the data
As Dr. Gold noted, the researchers didn't explore why there was such a jump in late-stage breast and colorectal cancer diagnoses and a drop in early-stage diagnoses—they just discovered that this is a trend. However, doctors have some theories. Dr. Gold stresses that the reasoning behind this is "multi-factorial," meaning there's likely more than one reason this is happening.
- Screening appointments have been postponed off and on due to the pandemic. Hospitals and medical centers only have so many resources, and many have canceled procedures like mammograms and colonoscopies at different points in order to divert medical staff to care for COVID-19 patients, Dr. Gold says.
- Patients have been nervous about interacting with the medical community. Hospitals and medical centers are often where seriously ill COVID-19 patients go to get help—and that's made people nervous about entering those environments, Richard Reitherman, MD, PhD, medical director of breast imaging at MemorialCareBreast Center at Orange Coast Medical Center in Fountain Valley, California, tells Health. "Medical facilities got reputations for being potential superspreader sites," he says. "That decreased motivation for people to get out and get screening tests."
- People had to quarantine—a lot. At certain times during the pandemic, patients were asked to stay at home under local government orders. Additionally, anyone with known exposure to COVID-19 was (and still is) asked to stay at home to quarantine so as not to infect anyone else. These circumstances have resulted in a lot of changed plans. "Patients started to get sick, family members got sick, and they all had to isolate or quarantine," Dr. Reitherman says. "That made it harder to leave home," he adds, noting that this could have caused missed doctors appointments.
- Hospitals and medical centers have had staffing issues. Many employees at hospitals and medical centers have had to stay home during the pandemic, too, which has resulted in staffing shortages. "Healthcare providers and technologists got sick, had family members who got sick, and had to social distance," Dr. Reitherman says. "They're also regularly in an environment with a higher infectivity rate, making it more likely they would get COVID."
- Screening simply hasn't been a priority for patients. Life has been the opposite of normal for more than two years, and non-urgent medical care just hasn't been a priority for many people who are trying to get through their days under less-than-ideal circumstances, Dr. Reitherman says.
The pandemic shouldn’t deter you from getting the screenings you need.
Going forward, it's important to prioritize all screenings you're eligible for, including those for breast and colorectal cancers, Dr. Reitherman says. The major preventative screenings you need to know about are listed below.
- Breast: Women should have the option to start screening with mammography once a year, starting at age 40, per the Centers for Disease Control and Prevention (CDC). Starting at age 50, they should get a mammogram every two years. The American Cancer Society (ACS) no longer recommends women do regular breast self-exams as long as they're undergoing regular mammograms. However, the organization stresses that "women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away."
- Colon: Unless you're high-risk for colon cancer (due, for instance, to family history of disease), you should start screening at age 45, per the ACS, which recommends average-risk patients get a colonoscopy every 10 years.
- Lung: The U.S. Preventive Services Task Force (USPSTF) recommends that people ages 50–80 with a history of smoking be screened every year if they meet certain requirements. These include currently smoking, having quit within the past 15 years, or having a 20 pack-year history. (This means having smoked a pack a day for 20 years, or two packs a day for 10 years, etc., per the National Cancer Institute. If you're unsure if you should be screened for lung cancer, consult your primary care doctor.)
- Cervical: According to the American College of Obstetricians and Gynecologists (ACOG), everyone ages 21 and up with a cervix should be screened every three years until age 65, at which point screenings can stop unless the patient has a history of unusual results.
- Skin: There is no uniform recommendation for skin cancer screening in the U.S. However, the American Academy of Dermatology (AAD) recommends that people do regular skin self-exams and see a dermatologist if they notice anything suspicious-looking.
If you're confused about which screenings you should be getting and when, ask your primary care doctor for guidance. "I'd recommend that everyone who is overdue for a visit with their primary care physician work to get an appointment set up as soon as possible," Dr. Gold recommends. "Their physicians can recommend appropriate cancer screening, which may include screening for breast, colon, lung, cervical, and other types of cancer. Also, these preventative health care visits are important for reasons besides cancer prevention as well, like heart disease and stroke prevention."
Screenings will likely become more common again as we transition to pre-pandemic normalcy, Dr. Reitherman says. Still, he urges people to advocate for their own health. "Don't expect somebody else to take care of you," he says. "You have to advocate for yourself and go to these screenings when it's time. And, if something seems or feels off, you need to speak up."
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