COVID-19 Prevented Early Cancer Screenings Leading to Incurable Cancer Cases

The coronavirus pandemic has led to a domino effect with economic and healthcare issues across the United States. With many focused on jump-starting the economy, others are openly wondering if COVID-19 will launch an epidemic of cancer?

 

Sally Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute in San Francisco. She contends “millions of Americans have put off ‘elective’ medical care to comply with state orders that they stay home.”

 

Ultimately, she says, those delays could result in excess deaths from non-coronavirus causes.

 

Pipes contends the health care industry needs a more nuanced response to the pandemic than blanket stay-at-home orders and bans on elective care.

 

“‘Elective’ does not mean ‘optional,’” she says in an op-ed for the Sun Journal, a newspaper published in Lewiston, Maine. “Medical providers classify care as elective, or ‘non-emergency,’ when it can be scheduled in advance. But such treatment is often critical and lifesaving. [1]

 

“Elective procedures account for 91% of all surgeries in the United States and include things like tumor biopsies, bone marrow transplants, joint replacements, and even heart bypass surgery.”

 

According to the SEER database, maintained by the National Cancer Institute (NCI), nearly 2 million Americans are diagnosed with cancer each year. When breast cancer is detected early (localized), the five-year survival rate is 99%. However, once breast cancer has spread, survival rates drop to 27%.

 

Similarly, the five-year survival rates for colon cancer is 90% for Stage 0 or I tumors.

 

“The pandemic and attendant stay-at-home orders have caused patients to put off routine cancer screenings,” Price says. “Mammogram and colonoscopy rates fell between 86% and 94% in March. One study estimates that during the past three months, more than 80,000 cancer cases have gone undiagnosed.”

 

Bottom line: Missed diagnoses are missed opportunities for early detection. Ultimately, that means diagnosis will linger far into the future, and cases that were once treatable will become incurable.

 

 NCI Director Ned Sharpless estimates an increase of 10,000 deaths during the next 10 years due to delays in diagnosing colon and breast cancers.

 

“For both these cancer types, we believe the pandemic will influence cancer deaths for at least a decade,” Sharpless said in a virtual joint meeting of the Board of Scientific Advisors and the National Cancer Advisory Board on June 15. “I find this worrisome as cancer mortality is common. Even a 1% increase every decade is a lot of cancer suffering.

 

“And this analysis, frankly, is pretty conservative. We do not consider cancers other than those of breast and colon, but there is every reason to believe the pandemic will affect other types of cancer, too. We did not account for the additional non-lethal morbidity from upstaging, but this could also be significant and burdensome.” [2]

 

Sharpless said the number of excess deaths would peak in the next couple of years. In an editorial in the journal Science, Sharpless noted the analysis is conservative and does not consider other cancer types. The analysis also does not account for additional nonlethal morbidity from upstaging. It assumes a moderate disruption in care that completely resolves after 6 months.

 

Sharpless added the analysis does not account for regional variations in response to the pandemic. These effects may be less severe in parts of the country with shorter or less severe lockdowns.

 

“Clearly, postponing procedures and deferring care as a result of the pandemic was prudent at one time, but the spread, duration, and future peaks of COVID-19 remain unclear,” he wrote. “However, ignoring life-threatening non-COVID-19 conditions such as cancer for too long may turn one public health crisis into many others. Let’s avoid that outcome.”

 

 

References

 

[1] Sally Pipes: Will COVID-19 launch an epidemic of cancer? https://www.sunjournal.com/2020/07/12/sally-pipes-will-covid-19-launch-an-epidemic-of-cancer/

 

[2] Sharpless: COVID-19 expected to increase mortality by at least 10,000 deaths from breast and colorectal cancers over 10 years. https://cancerletter.com/articles/20200619_1/

 

[3] COVID-19 and cancer. https://science.sciencemag.org/content/368/6497/1290