Epic data on drop in cancer screenings during COVID shutdown

Back to cancer screenings after COVID shutdowns

If you’re reading this, I’m sure you are aware of the importance of early detection for cancer of any kind.

Yet smart people (especially men) routinely procrastinate anyway, putting off doctor visits and recommended screenings like mammograms that could be lifesaving. Due to COVID-19, which made it impossible to schedule a screening even if you wanted to, many people have fallen further behind.

Aggregate data from Epic, one of the largest electronic medical record software companies in the country, showed that routine cancer screenings like mammograms fell off a cliff during the height of the pandemic. According to Epic, appointments for cervix, colon, and breast cancer screenings were down between 86% and 94% in March in comparison to average volumes in the past three years. See the complete Epic cancer screening data.

As a result, the healthcare community is concerned that we may be facing another public health crisis in the future because of delayed diagnoses and treatment of many diseases, not only cancer. And now that restrictions on seeing a medical provider for routine exams have been lifted or eased in most places, the time is now to schedule your applicable screenings or a check-up of symptoms if warranted.

Past due for your mammogram or colonoscopy?

I understand procrastination since I’m quite skilled at it myself. I know a medical appointment adds one more thing to a packed schedule. I understand the fear of possible bad news compared to the comfort and bliss that ignorance does, indeed, provide. Yet it’s vitally important to follow applicable screening guidelines and seek medical attention if you notice any abnormal and persistent symptoms or signs.

No significant abnormality was found

This is what every person wants to hear after a cancer screening procedure. I can tell you from experience—after hearing that I had breast cancer or a recurrence three times in the past 20 years—that the best way to ensure this good news is to monitor your health.

  • Even if you have strange lumps or bumps or other vexing symptoms, they usually don’t turn out to be cancer, especially when they’re nipped in the bud. By putting off medical attention, all you gain is more time to worry and ruminate. Why do that to yourself and your loved ones?
  • If something is wrong, the right screening at the right time can uncover issues or rogue cells before they decide to take a walk on the wild side and develop into something malignant. If you give cancer cells a centimeter, they will keep adding more centimeters to their territory.

If you’re due, please, call your primary care doctor. Preventative care is much easier, less costly, less worrisome, and less time-consuming than a cancer diagnosis. Need I say more?

To help you, I have compiled the following recommendations and information from the American Cancer Society on some of the most common and potentially deadly cancers. (In alphabetical order)

American Cancer Society guidance on screening and symptoms

Breast cancer screening

Women at average risk (no personal or family history, no BRCA or other applicable genetic mutation)

  • Between 40 and 44, optional yearly mammogram
  • Between 45 and 54, yearly mammogram
  • 55 and older, mammogram every other year or continue yearly for those in good health and expected to live at least 10 more years.

Women at high risk (have a known BRCA gene mutation; had radiation therapy to the chest between the ages of 10 and 30 years; have Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome.

  • Yearly breast MRI and mammogram, typically starting at age 30.

Colon and rectal cancer screening

For people at average risk:

  • Regular colon/rectal cancer screening starting at age 45, with either a stool-based test or a visual exam. Screening intervals vary from yearly to every ten years, depending on the test and other variables. Discuss which test is right for you with your physician.
  • People in good health and with a life expectancy of more than 10 years should continue regular screening through the age of 75.
  • People ages 76 through 85 should be screened based on personal preferences, overall health, and prior screening history.
  • People over 85 should no longer get colon/rectal cancer screening.

For people at high risk, screening may begin before age 45, may require specific test types and more frequent intervals. In addition, the US Multi-Society Task Force on Colorectal Cancer (USMSTF) has published guidelines for people at high risk for colon/rectal cancer, which are best discussed with physician guidance.

Colon/rectal cancer risks include a personal or family history; personal history of ulcerative colitis or Crohn’s disease; hereditary syndromes like familial adenomatous polyposis (FAP) or Lynch syndrome; history of radiation to the abdomen or pelvic area to treat a prior cancer.

Leukemia

With several kinds of leukemia and no screening recommendations, leukemia detection requires early attention to common symptoms:

  • Feeling tired
  • Weakness and fatigue
  • Feeling dizzy or lightheaded
  • Shortness of breath
  • Pale skin
  • Infections that don’t go away or keep coming back
  • Bruises or small red or purple spots on the skin
  • Abnormal bleeding, such as frequent or severe nosebleeds or bleeding gums

Other non-specific (general) symptoms of leukemia can include:

  • Loss of appetite and unintended weight loss
  • Fever
  • Night sweats
  • Swollen lymph nodes

Pay special attention to these symptoms in children, as leukemia is the most common cancer in children and teens.

Liver cancer screening

For people at higher risk: (people with cirrhosis, hereditary hemochromatosis, or chronic hepatitis B infection)

  • Some experts recommend screening with alpha-fetoprotein (AFP) blood tests and ultrasound exams every 6 months.

Otherwise, pay attention to the following symptoms:

  • Loss of appetite and unintentional weight loss
  • Feeling very full after a small meal
  • Nausea or vomiting
  • Enlarged liver or spleen, felt as fullness under the ribs
  • Abdominal swelling and/or pain
  • Yellowing of the skin and eyes (jaundice)
  • Enlarged veins on the belly that can be seen through the skin

Lung cancer screening

  • Yearly low-dose CT scan (LDCT) for current or former smokers. (But really, you’re still smoking? Give it up, for yourself and your loved ones who want to keep you around as long as possible.)

Lymphoma (Non-Hodgkin)

At this time, there are no wide recommendations so self-screening is key, as sometimes lymphoma can be found early. Enlarged lymph nodes are a common symptom, most often in the neck, armpit, or groin.

Ovarian cancer

There hasn’t been much success so far from research to develop a screening test for ovarian cancer and there are no recommended screening tests for women who do not have symptoms and are not at high risk. The two tests used most often (in addition to a complete pelvic exam) are transvaginal ultrasound (TVUS) and the CA-125 blood test.

Some organizations state that TVUS and CA-125 may be offered to women who have a high risk of ovarian cancer due to an inherited genetic syndrome such as Lynch syndrome, BRCA gene mutations or a strong family history of breast and ovarian cancer. Yet it has not been proven that using these tests for screening lowers the chances of dying from ovarian cancer, so no major medical or professional organization recommends their routine use.

The most common symptoms of ovarian cancer are commonly caused by non-cancerous diseases or cancers of other organs:

  • Bloating
  • Pelvic or abdominal pain
  • Trouble eating or feeling full quickly
  • Urinary symptoms such as urgency or frequency
  • Pain during sex
  • Constipation
  • Heavier than usual or irregular menstrual bleeding

Pancreatic cancer

Early pancreatic cancer often does not cause any signs or symptoms, and by the time they do, they have often grown or spread outside the pancreas. If you have any of the following symptoms, they are most likely due to other issues, but it’s important to get checked by a doctor regardless:

  • Jaundice and related symptoms
  • Belly or back pain
  • Weight loss and poor appetite
  • Nausea and vomiting

Various blood and imaging tests are used to discover and diagnose pancreatic cancer.

Prostate cancer screening

Men should not be screened unless they have received information about the uncertainties, risks, and potential benefits of the prostate-specific antigen (PSA) blood test. They should have a discussion with their physician at the following ages:

  • Age 50 for men who are at average risk and expected to live at least 10 more years.
  • Age 45 for men at high risk, including African Americans and men with a father or brother who were diagnosed with prostate cancer before age 65.
  • Age 40 for men at highest risk—more than one first-degree relative who had prostate cancer at an early age.

Uterine Cancer

Without screening options, it’s important to know the signs and symptoms of uterine cancer and see your doctor right away if you have them. Unfortunately, many uterine sarcomas reach an advanced stage before signs and symptoms are present.

While abnormal discharge is most often a sign of infection or another non-cancer condition, it also can be a sign of cancer, so check with your doctor, especially if they persist. In addition:

  • About 10% of women with uterine sarcomas have pelvic pain and/or a mass that can be felt.
  • About 85% of patients diagnosed with uterine cancer have irregular vaginal bleeding (between periods) or bleeding after menopause. This symptom is more often caused by something other than cancer, but it’s important to have any irregular bleeding checked right away. If you are post-menopausal, any vaginal bleeding or spotting is abnormal and should be reported to your doctor as soon as possible.

 

Last word on early cancer detection

Regarding any of the above-listed symptoms, or any others not mentioned, it’s important to seek immediate medical attention if they are persistent and different from what’s normal for your body and general health. This is especially important for the cancers that tend to be asymptomatic until the later stages of the disease, like pancreatic cancer.

Cancer can be a formidable foe.

I say this not to cause fear or anxiety, but to empower you and encourage you to be reasonably vigilant. Please, pay attention to persistent, abnormal symptoms and follow all cancer screening recommendations that apply to you.

I would rather that you practice the principles of Stage Four Living (Stay in the game, Lighten your load, Honor the journey) in good health!