You’d think that a decrease in cancer diagnoses over the past few months would be good news.
Dig deeper, though, and a more complex truth emerges: It means that preventive medical care has declined since the coronavirus pandemic began.
With stay-at-home orders and concerns about COVID-19 transmission, many people have put off medical screenings. Because cancer and other diseases don’t take vacations, experts urge people not to take time off from routine medical care.
“There has been an estimated 46 percent drop in the number of cancer diagnoses in the U.S. since last spring,” said Thomas Buchholz, M.D., medical director of the Scripps MD Anderson Cancer Center in San Diego. “That’s a direct consequence of postponing screenings. We’re open for safe cancer screenings. We’ve taken care that screenings, colonoscopies and other tests are safe, so that if people are confronted by cancer, they will be able to tackle it early.
“We hope to get the message out to individuals that cancer screenings are important to continue despite the ongoing pandemic.”
Hesitant patients
It’s not only oncology tests that have been put off. According to a study published in September by the American Academy of Family Physicians (AAFP), more than 40 percent of American adults have delayed or avoided receiving medical care because of concerns about COVID-19.
In March and April, people were advised not to seek out elective or preventive tests and procedures. But medical facilities and doctor offices all across the country quickly adopted new safety protocols.
Those protocols include mask requirements, clean and disinfected spaces, and appointments staggered to eliminate crowded waiting rooms. But some people are still hesitant.
David Bazzo, M.D., a family medicine physician and interim chairman of the Department of Family Medicine and Public Health at the University of California San Diego, says that although some patients have come to see him in person, many have delayed visits because of worries about the coronavirus.
(Courtesy photo)
“I can definitely tell you that many of my patients have delayed visits due to fear of COVID,” said David Bazzo, M.D., interim chairman of the Department of Family Medicine and Public Health at the University of California San Diego.
“There are different levels of fear. Some patients have come to see me, person to person. But if I ask them to go to a clinic or a medical facility such as a hospital, the fear is at a higher level.”
Bazzo, who is also president of the California Academy of Family Physicians, pointed out that many patients with hypertension, diabetes or coronary artery disease need regular chronic-care follow-ups. But some of them are reluctant to come into the office.
“They are much more comfortable with telemedicine appointments,” he said. “But, at some point we need to see them in person.”
Weighing the risks
The fear is understandable, but experts worry that delaying critical screenings will have repercussions long after the pandemic. That is the view expressed by Norman “Ned” Sharpless, M.D., director of the National Cancer Institute in Rockville, Md., in a June 2020 Science magazine editorial.
He cited modeling that projects almost 10,000 excess deaths from breast and colorectal cancer in the next 10 years associated with delays in the screening and diagnosis of these two cancers.
Scripps’ Buchholz said the screening of other cancers may be a little more individualized, based on a person’s genetic makeup and medical history.
“We’re open for safe cancer screenings,” said Thomas Buchholz, M.D., medical director of the Scripps MD Anderson Cancer Center in San Diego. “We’ve taken care that screenings, colonoscopies and other tests are safe, so that if people are confronted by cancer, they will be able to tackle it early.”
(Courtesy photo)
“Prostate cancer is more aggressive in African American males, for example,” he said. “If an African American man is 60 years old with a family history of prostate cancer, there’s a strong indication that he should have a blood test. For an 88-year-old White male, getting a prostate test may not be necessary.
“Another thing to be careful about is that we’re here in our Southern California sunlight all the time. If people feel something’s wrong with their skin, they should get it checked out.
“Our systems are exceedingly safe,” Buchholz said. “The risk of not seeking attention can be a greater risk than the pandemic.”
A concerning statistic from the AAFP report is that 55.5 percent of Hispanic adults nationwide have avoided getting any medical care during the pandemic. They are also a population hit hard by COVID-19.
The most recent data from San Diego County’s preliminary COVID-19 Race/Ethnicity Summary, released on Sunday, showed that the case rate per 100,000 county residents for Hispanics or Latinos was 5,760, compared with 1,837 for Whites. Those figures may explain delays in preventive care.
Because of the current coronavirus surge, some Southern California hospitals may need to decrease or forgo elective procedures. Patients impacted by this will be informed and encouraged to reschedule. In the meanwhile, doctor offices and medical clinics remain open and adhere to safety protocols.
“We recommend continuing to proceed with scheduled cancer screenings and visits to medical clinics as appropriate,” Scripps’ Buchholz said. “They will not have an effect on our ICU capacity.
“Delaying a cancer diagnosis increases the risk of finding more advanced disease, which has the potential to be a more serious situation.”
While the immediate focus of doctors like Buchholz and UCSD’s Bazzo is on keeping people healthy during the pandemic, they believe this crisis may result in future medical advances.
“A lot of creative thinking on how to deliver care has been taking place,” Bazzo observed. “We were pushed into telemedicine and have become very good at it. I don’t think telemedicine will go away. We have learned to do it properly, and patients have seen how convenient it is.”
Buchholz is of like mind. He noted that the pandemic may offer an opportunity to examine how preventive care is delivered.
“Advances like telehealth make care more convenient for families and more cost-effective for medical facilities,” Buchholz said. “I encourage us to think of how we deliver preventive care — it can change.
“But that in no way suggests we shouldn’t get preventive screenings. The evidence is clear that they are life-saving.”
Friendly reminders
During the coronavirus pandemic, it may seem safer to delay preventive care. But with safety protocols in place, it can actually be more dangerous to skip important medical appointments, screenings and vaccines. Here are a few recommendations:
- Get your flu shot — now more than ever.
- Stay on track for colonoscopies, mammograms and other cancer screenings.
- Be sure you’ve had your annual physical in 2020.
- Keep your vaccines up to date.
- People with chronic conditions — including heart disease, cancer, lung disease, diabetes and arthritis — need to be consistent with their medical appointments and tests.
- Regular prenatal care for pregnant women is vital for their health and that of the baby.
- It bears repeating: If you haven’t already, get your flu shot now.
When to get what
It can be confusing to determine which tests and shots are needed at various stages in our lives. Here are some resources that can help:
My Healthfinder, from the Office of Disease Prevention and Health Promotion: www.health.gov/myhealthfinder
By inputting age and gender, you can find out what screenings you and your loved ones may need.
Child immunization schedules, from the Centers for Disease Control and Prevention: www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html
This parent-friendly list has the recommended vaccinations for infants and children (birth through 6 years).
Recommended vaccines by age, from the CDC: www.cdc.gov/vaccines/vpd/vaccines-age.html
Press the appropriate tab to see the vaccines recommended for different age groups.
Wood is a freelance writer.
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