The COVID-19 pandemic has caused many people to delay or avoid routine cancer screenings and other preventive healthcare. USA Today reported the results of a Prevent Cancer Foundation survey suggesting that 35% of Americans missed routine cancer screenings because of COVID-19. As a result of these delayed appointments, the U.S. saw a combined 46% decrease in the diagnoses of certain cancers, including:
- Gastric (stomach cancer)
The study, published in the August 4 edition of JAMA Open Network, was reported on by U.S. News & World Report. The article goes on to say that the drop in cancer diagnoses is not due to the fact that fewer people are getting cancer, but rather a “COVID-driven reluctance to get screened."
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Missed screenings and treatments could result in 10,000 deaths from breast and colorectal cancer, according to an editorial written by the director of the National Cancer Institute. Here’s what you need to know about screening, prevention and care when it comes to COVID-19 and cancers affecting women, from the team of experts at the Sarah Cannon Cancer Hospital at Medical City Plano.
In real life: Postponing preventive breast care during the pandemic
Q: Have any of your patients postponed their screening mammograms because of COVID-19 and later been diagnosed with cancer?
The answer is yes, says Minh Nguyen, MD, a breast radiologist at Sarah Cannon Cancer Hospital at Medical City Plano.
Dr. Nguyen says patients who delayed care because of COVID-19 typically fall into one of three categories:
- Patients who were seen in March for their annual checkups but didn’t return when told they needed further evaluation
- Patients who did return and were told they needed a biopsy for a concerning finding, but didn’t come back for the procedure until three or more months later
“By then,” says Dr. Nguyen, “you can see the tumor, or the lesion, has gotten bigger compared to what we saw back in March.”
- Patients who were due for their yearly mammogram in March or April but didn’t make an appointment until six or more months later
Dr. Nguyen says it’s hard to know for sure if these patients’ breast cancers would have been detected when they were originally scheduled for screening, but “you can make an assumption, had they come in for their checkup in March or April, we probably would have found the lesion much smaller.”
Breast screenings and diagnostics during COVID-19
Q: Should women be concerned about visiting a screening or diagnostic facility during the pandemic?
Safety is obviously a concern for any patient who enters a healthcare facility during COVID-19 — and our highest priority. Solis Mammography, Medical City Healthcare’s imaging partner, has a number of measures in place — in accordance with state, local and CDC guidelines — to ensure the safety of patients who visit for screening and diagnostic procedures.
Dr. Nguyen says that to help keep everyone safe, patients (as well as staff members) are screened at the front door with a temperature check and questions regarding symptoms and exposure to people with COVID-19. Other enhanced safety precautions include:
- Masks are required to enter the facility
- Chairs and check-in lines are spaced apart in the waiting room for proper social distancing
- Common areas and high-touch surfaces are continuously and thoroughly cleaned
- All staff members wear personal protective equipment (PPE)
Q: When should breast screenings start?
“Women should start being taught breast self-exam in their teens,” says Beth Anglin, MD, a breast surgeon at Sarah Cannon Cancer Hospital at Medical City Plano. “Women should start seeing a physician yearly for breast exams starting at 20 until 40, when their mammograms start. That can usually coincide with their well-woman exam.”
Seeing a breast surgeon during COVID-19
Q: Should women who have symptoms, such as a breast lump, or women who have been diagnosed with breast cancer, be worried about visiting their physician’s office or a hospital during the pandemic?
“I would say that physician’s offices and hospitals are potentially safer than other places you could go,” says Dr. Anglin. “In my office in particular, we’ve separated how we see our patients … so that we limit the number of people in the waiting room.”
Dr. Anglin says screening protocols are also in place, with health checks and COVID-19 symptoms/exposure questions for everyone—patients and staff members alike.
“I get my temperature checked every time I walk in the office,” says Dr. Anglin.
Additional safety measures include:
- Universal masking
- Face shields during visits
“We are really taking precautions to make it safe,” Dr. Anglin says.
Q: When should someone see a breast surgeon?
These signs and symptoms indicate that you should make an appointment to visit a breast surgeon. Call a breast surgeon right away if you:
- Feel or see a lump
- Have nipple discharge
- See changes in the visual appearance of your breast, such as nipple inversion or skin dimpling
Dr. Anglin says a breast surgeon can help you figure out what the next steps should be, such as breast imaging to further evaluate your symptoms.
“I’d like to mention that genetics — a strong family history of breast cancer, ovarian cancer, pancreatic cancer — those can be indications for genetic risk for breast cancer,” says Dr. Anglin. “In those scenarios … you should really pay attention to your breast health.”
Gynecologic cancer diagnosis and treatment during COVID-19
Q: Does it matter if you wait a few months for your cervical cancer screening (pap smear)?
“The guidelines on how we screen for cervical cancer have evolved tremendously over the last 15 or 20 years,” says Thomas Heffernan, MD, a gynecologic oncologist at Sarah Cannon Cancer Hospital at Medical City Plano. “That really has largely to do with the fact that we’re collecting more and more data — millions of women are getting pap smears — and as a result our data set has grown. We’ve been able to better understand just how often we really need to screen people. As a result of this, screening guidelines have changed quite a bit in recent years.”
OLD GUIDELINES: Pap smears were recommended every year beginning at puberty and continuing indefinitely
NEW GUIDELINES: Pap smears are recommended every 3 to every 5 years beginning at age 21, depending on age and other risk and health factors
“With that in mind, waiting for three to six months is not a terribly long time to wait for a pap smear,” Dr. Heffernan says.
Q: Should patients be concerned about coming to the hospital for gynecologic surgery during COVID-19?
“In the operating room here, for example, COVID testing is done 48 hours before procedures,” Dr. Heffernan says. “We get those results and are able to screen those patients very accurately before the procedure begins. There are patients who need surgery while they’re actively testing positive for COVID — that happens and it’s not ideal — but it can be done and is done and the hospitals and surgeons and physicians and nurses have figured out how to do that and do it safely.”
All Medical City Hospitals have enhanced safety precautions in place for all patients, including surgical patients. Visit our Coronavirus Resource Hub for more information and watch the video to learn what to expect before surgery or a procedure.
Q: When should cervical cancer screenings start?
Screening guidelines for cervical cancer:
- Age 21-29: Pap smear every 3 years
- Age 30-65: Pap smear and HPV test every 5 years
- Age 65+/post-hysterectomy: No testing is necessary
“These are pretty new changes to the guidelines, and certainly not what most gynecologists grew up doing,” Dr. Heffernan says. “It’s also not what most patients grew up doing, so there’s a little bit of anxiety on both sides of the equation. Many patients will get pap smears more frequently and I don’t think there’s anything wrong with that.”
Q: When about screenings for other gynecologic cancers?
Dr. Heffernan says there aren’t specific tests or blood work that screens for other gynecologic cancers such as ovarian cancer and endometrial cancer. For these cancers and most other diagnoses, he says the key to early detection is communication.
“Patients really do need to see their physician once a year for their annual examination, their well-woman exam,” says Dr. Heffernan. “It’s in the course of that conversation and examination that problems are frequently caught early.”
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