Dr. Constantine Mantz recalls a patient he saw recently who had noticed a lump in her breast very early in the year.
“She was unable to go for her mammograms and ultrasounds as had been prescribed by her family physician because facilities had shut themselves down,” said Mantz, a radiation oncologist and chief policy officer at GenesisCare.
It wasn’t until late July that the patient had a biopsy, and in the intervening months, the mass in her breast had doubled in size.
“When it was finally diagnosed, the cancer had already traveled to the lymph glands underneath the arm,” Mantz said.
The more advanced cancer required more radical surgery and more aggressive radiation treatment.
“If I had seen her earlier in the year, I’m almost certain her opportunity for a cure would have been greater, and the treatment necessary to achieve that cure would have been far less taxing for her,” Mantz said.
That is an occurrence that may soon be all too common, as the coronavirus pandemic has caused a substantial drop in cancer screenings, and there is little sign that the trend is reversing.
“There is an overwhelming pattern of delays and decline in cancer screenings,” said Dr. Debra Patt, an oncologist and breast cancer specialist at Texas Oncology.
Patt was the lead researcher on a joint study of Medicare billings by the consulting firm Avalere Health and the Community Oncology Alliance. The study found that screenings for cancers of the breast, lung, and colon saw steep drops in April when compared to the previous year, of 85%, 75%, 74%, and 56%, respectively.
Claims data from UnitedHealthGroup shows that from January to August, mammograms and cervical cancer screenings are down 20% from the same time in 2019, while colorectal cancer screenings are off 25%.
In the early months of the pandemic, many medical practices were required to shut down or were redirected to treating COVID-19. Additionally, the Centers for Disease Control and Prevention advised people not to go for routine visits. Although most practices reopened, many patients have not visited their physicians or other healthcare providers due to fear of contracting the coronavirus. A Morning Consult poll from May found that 62% of respondents would not visit the hospital for non-COVID-19-related care. Forty-eight percent said the same about their primary care doctor.
Dr. Harvey Kaufman, senior medical director at Quest Diagnostics, suggests that reluctance may have continued into the fall.
“I have a sister who is an OB/GYN and a brother who is a neurologist, and their offices will contact patients a week before their scheduled appointment and then the day before,” he said. “Sure enough, 20% of the patients don’t show up … There is still this cautious behavior that is keeping people from returning to their routine visits.”
Perhaps more troubling is the patients who have not shown up to receive treatment.
“When we’re looking at patients who missed chemotherapy drugs, those are usually patients who have already been diagnosed and a treatment regimen has already been established,” said Milena Sullivan, a principal with the policy practice at Avalere.
A study by Avalere in May found that infusion treatments for chemotherapy drugs dropped 26% in March and 33% in April.
The data suggests that people who put off screening during the early part of the pandemic are still putting it off.
“Over the summer, screening volume nearly returned to pre-pandemic levels,” said Eric Hausman, a spokesman for UnitedHealthGroup. “Although screening rates have nearly recovered, they aren’t making up for the loss in the spring.”
Data from Quest Diagnostics shows a similar pattern.
“The decline bottomed out in April, and then in May and June, screening bounced back to baseline,” said Kaufman. “But given that there was a gap, one would hope it would bounce back way beyond baseline, but that hasn’t happened. More recently, in August and September, we are seeing a decline again.”
The consequences will likely be severe in the longer run, from cancers that are harder to treat to increased deaths.
On Monday, Kantar Health, a healthcare data, analytics, and research provider, released a study showing that nearly 2,800 more women could die from breast cancer over the next decade due to delays in treatment.
Patt says that patients should not be afraid to see their medical providers.
“A lot has changed in America since April,” she said. “Doctors’ offices are safe places to be.”
