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Cancer Can't Wait: Why Screenings Are Still Important In a Pandemic

Fewer cancer screenings mean fewer diagnoses and fewer options for potentially life-saving early treatment.


Ignoring Alarm Clock

This is a downward trend we don’t want to see: fewer patients are getting their recommended cancer screenings. According to a report from Epic, a vendor for electronic health records, preventive screenings are down 86-94% since March 2020, when the coronavirus pandemic caused initial shelter-in-place orders and limited non-urgent medical procedures.

But health risks don’t sleep during a pandemic.

“In general, screening exams are beneficial because they help us detect serious diseases before they would otherwise be noticed by the patient,” says radiologist Rachel Preisser, MD. This is especially true with cancer. “The smaller a cancer is when it is found, the easier it is to treat and achieve remission,” she says.

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Three of the most common cancer diagnoses in Iowa — breast cancer, colorectal cancer and prostate cancer — all saw significant decreases in preventive screenings during this time. But the impacts of this disruption could last for the next decade at least.

The domino effect could look like this: Fewer preventive cancer screenings done now could lead to more later-stage diagnoses in the future (which could have been caught earlier). And along with later-stage cancers comes declining prognoses and fewer avenues for treatment.

While delaying preventive screenings for a few months isn’t cause for too much alarm, it can be a red flag when a few months turns into many months. And then? “Before long, it's been several years,” says urologist Steven Rosenberg, MD. “Then it really matters.”

“I encourage patients who have had their prior procedure postponed or canceled to reach out to us and reschedule their appointments,” reminds gastroenterologist Laura Dakovich, DO. Depending on your provider, you may be able to schedule online or pick up the phone to make an appointment.

Recommended breast cancer screenings aren’t something to sleep on.

For Iowa women, breast cancer is the most common cancer diagnosis. “While there are different factors in play,” says Dr. Preisser, “all of the major societies agree that the most lives saved from breast cancer occur when screening starts at age 40 and continues every year after that.”

Dr. Preisser also recommends women considered high-risk start screening earlier and strongly consider adding a yearly MRI to their screening strategy.

What happens when you miss an annual preventive screening? Regardless of age, even participating every other year could lead to almost 30% of breast cancer diagnoses being missed.

Health Check: Many factors contribute to your risk of breast cancer — some you can control, and others you can’t. Sex, age, family history, genetic mutations and breast density aren’t changeable. While other risk factors like hormone use, reproductive history, physical activity and weight can be influenced by choices you make. When it comes to breast changes, always alert your provider if you notice any masses, constant pain, changes to your skin, enlargement or nipple discharge (especially if clear or bloody).

The earlier breast cancer is detected, often the less invasive (and shorter) the course of treatment. As cancer size increases, chemotherapy and more extensive treatments may be necessary. Not only are these treatments more difficult for a patient, says Dr. Preisser, they are also less successful for complete remission and come with a steeper price tag.

“Even as breast cancer treatments have improved with time, the greatest benefits are seen in women who participate in a screening mammography program,” Dr. Preisser says. “Screening mammography is the only test we have that has been proven to reduce breast cancer deaths.”

One big reason you shouldn’t avoid your colonoscopy: Colorectal cancer is largely preventable.

The good news: As the rate of preventive screenings increases, the incidence of colorectal cancers has decreased. But the bad news is that during the pandemic, colon cancer screenings plummeted from 3,000 a week to 400 based on the national analysis from Epic.

“The goal of a colonoscopy is prevention,” Dr. Dakovich says. If a polyp (a small tissue growth in the colon) or cancer is found early, treatments have a higher success rate.

Current recommendations for a screening colonoscopy begin at age 50 with a procedure every 10 years for those deemed average risk. But if you have a family history of colorectal cancer or a type of polyp known as an adenoma, your provider may suggest preventive screenings at an earlier age.

Health Check: Risk factors for colorectal cancer includes family history, inflammatory bowel disease (like Crohn’s disease) and lifestyle factors such as weight, physical activity, tobacco use and diet. Talk to your doctor if you’re experiencing blood in your stool, unexplained weight loss or stomach pains that won’t go away.

“Here at The Iowa Clinic, we have a policy that helps assure safety,” says Dr. Dakovich. “We are following not only state and national guidelines, but the recommendations of our gastrointestinal societies in regards to personal protective equipment, pre-procedural COVID-19 testing and social distancing.”

When it comes to prostate cancer screening, early detection is key.

Most providers agree that an annual prostate-specific antigen (PSA) blood test and a digital rectal exam should become part of preventive care at age 50 for those at normal risk of prostate cancer. If prostate cancer is detected early, the five-year survival rate is nearly 100%.

And what makes preventive screening so important? Prostate cancer is asymptomatic until it’s metastatic. Meaning, you don’t experience any symptoms of prostate cancer until it’s spread outside of the prostate to other parts of your body. “You can't rely on symptoms and be able to find it while it's still curable,” Dr. Rosenberg says.

Prostate cancer is the most common cancer and the second-leading cause of cancer death in men. “It's slow-growing, but the implications of finding it after it's spread are pretty significant,” says Dr. Rosenberg.

Health Check: The prostate gets larger as you age (known as benign prostate enlargement). This can lead to urination troubles like slow stream, difficulty urinating and even blood in the stream. And while you should always let your provider know about those things, they’re usually not signs of prostate cancer.

“You need to be on top of it,” reminds Dr. Rosenberg. “If something's changed with the annual exam or the blood test, you can catch it early. You want to find it before it's spread."

Your safety — and the safety of our staff — remain our top priority.

While our focus on your safety hasn’t changed, our precautions have: touchless check-in, hand sanitizers stationed throughout the clinics, temperature screenings, masks, face shields, limiting or eliminating waiting rooms, disinfection of rooms and surfaces — and more.

If you have questions about current safety precautions or your health, please reach out to your provider. Together, we can make sure you feel comfortable and safe during your preventive cancer screening appointment.

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