Delayed Screenings Drive Up Later-stage Cancer Diagnosis And Treatment

ALTON - If you’ve watched an NFL game this season, chances are you’ve seen messages aimed at getting people to resume cancer screenings that, in some cases, dropped by as much as 90% during the COVID-19 pandemic.

The American Cancer Society teamed up with the NFL for its Crucial Catch campaign to encourage people to catch cancer early, when it may be easier to treat. The campaign includes NFL-issued Crucial Catch game day apparel featuring a multicolored logo representing all cancers and other awareness-raising reminders such as on-field multicolored Crucial Catch stencils.

James Piephoff, MD, director of Radiation Oncology at the OSF Moeller Cancer Center in Alton, Illinois, welcomes the awareness campaign. He says since the start of the pandemic, patients have delayed mammograms, colonoscopies, CT lung scans, and other screenings at alarming rates. Among OSF HealthCare patients, there was a drop of 26% in mammography and a 29% drop in colonoscopies from 2019 to 2020.

The American Cancer Society estimates the drop in preventive screenings for five common cancers could lead to delayed or missed diagnoses for 80,000 people nationwide. Here is how it breaks down in declines from 2019 to 2020, the latest year for which data is available: mammography (-87%), pap smears (-83%), colonoscopies (-90%) lung CT scans (-37%), and PSA screenings (-60%).

Dr. Piephoff says missed screenings are resulting in patients receiving a cancer diagnosis at a later stage.

“There are many patients I’ve seen that have been diagnosed with their cancer that would have been diagnosed several months or even a year earlier, if they had screening at the appropriate time. In almost all instances, being diagnosed earlier is better for prognosis, in both how we expect you to do and for treatment options.”

A questionable screening result could lead to the need for additional imaging or a biopsy to confirm a cancer diagnosis. At times, that could mean an additional few weeks to a month before diagnosis and a treatment plan. With some aggressive cancers the lost time can make a difference in successful treatment.

“The difference between earlier stages and Stage 4 breast cancer is that earlier stages are generally treatable and curable and you’re also more likely to have the option to preserve your breast rather than have to have your breast removed. If you’ve delayed your screening to the point where it has progressed to Stage 4 cancer, then the cancer is treatable but it’s not curable.”

Telling a patient they have cancer is never easy, but it’s harder when it's later-stage and more difficult to treat. Dr. Piephoff has heard regrets from those patients who skipped a screening due to their fears of contracting COVID-19.

“When you’re diagnosed with cancer, the last thing you want to do is to be thinking backwards. You want to be thinking forward to attacking the cancer and treating it in the best manner possible and not be wondering what if?”

OSF HealthCare has taken precautions after resuming non-emergency medical care following the early months of the pandemic. In addition to rigorous cleaning and sanitizing, OSF has limited visitors, required screening and masking for entry to medical buildings, limited time in waiting rooms, spaced out appointments, and implemented the use of virtual care, when possible, to reduce the number of patients in medical facilities.

Jill Pruitt, an oncology navigator, recently saw a patient who missed a scope that he typically receives because he is at high risk for throat cancer. She said it was heartbreaking for him to receive a devastating diagnosis because of a missed screening.

"The patient had an underlying medical condition and he knew he should have the test, the scope done every few years, and he’s been following it but he said last year he didn’t have it done due to COVID, and then he finally did have it done and they found something that was cancer.”

Pruitt understands people tend to avoid what can be uncomfortable but she says there’s no reason to delay getting regular and needed cancer screenings.

“You know you find it at a very early stage, surgery, you’re cured, versus Stage 4, its metastasized – chemo, radiation for the rest of your life. It’s very important to get your screenings done and don’t use COVID as an excuse!”

Pruitt recommends staying in contact with your primary care provider to manage your health. Women should do regular, monthly self-breast exams that can detect cancer in between mammograms and visit https://www.osfhealthcare.org/c/personal/.