The Unseen Consequence of Covid-19 on Cancer Screenings

This piece originally appeared on katiecouric.com.

Covid-19 has claimed millions of lives around the globe. While social distancing is key to staying healthy, avoiding routine medical screenings could have dire consequences down the road.

Did you know that colorectal cancer is the second leading cause of cancer deaths among men and women combined in the US? March marks Colorectal Cancer Awareness Month, and we are working with our partners at Exact Sciences, the makers of Cologuard®, to help raise awareness about the disease. We’ll be sharing crucial information on the importance of screening, details about who is most at risk, and how you can take action to best ensure early detection and prevention of the disease. 

In the past year, Covid-19 has claimed over half a million lives in the US alone. While this number is already staggering, there is a secondary consequence of Covid-19 that will likely cause hundreds if not thousands of unnecessary deaths- missed colorectal cancer screenings. This is a matter of national urgency— President Biden even recently released a proclamation on the issue, saying “I urge every American to take the precautions they need in order to stay vigilant against cancer — don’t delay your recommended screenings.” We spoke with Dr. Lisa Ravindra, Board Certified Internal Medicine Physician and Assistant Professor of Medicine at Rush University Medical Center in Chicago, about the long-term impacts of the pandemic on colorectal cancer, the different screening options available to patients, and why you have no excuse to wait another day if you’ve been putting off your screening.

Wake Up Call: Before the pandemic, colorectal cancer deaths have been decreasing for older Americans. Why is that? 

Dr. Lisa Ravindra: Our screening efforts for colon cancer have been very good over the last decade, so the incidence and deaths related to colon cancer have decreased. As we screen more people, we can find cancers and precancerous lesions much earlier. When they’re treated early or removed, there are far fewer deaths and complications down the line.

That’s the main reason why the numbers had been falling, but since the pandemic, a lot of people have missed screenings. We know for sure that there are early cancers and pre-cancerous lesions that are going undiagnosed or will be delayed in being diagnosed because of these missed screenings. 

What will be the long term impacts of these missed screenings?

I think it depends. At the beginning of the pandemic, so now we’re talking a year ago, screenings dropped off by almost 90%. But then starting in mid-June, appointments and screenings started to pick back up, but there’s still a backlog. The latest study that I read from September of 2020 showed 36% of adults had delayed care in the previous months. It’s going to be hard to know until we get more updated data if that number is improving, but that’s still a significant chunk of people that may not have gotten screened. Another more recent study showed that the disruption of cancer screenings will mean that many cancers won’t be detected in patients until they’re in later stages and will require more complex care, with lower likelihood that patients will respond to therapy and be cured of these diseases. Years after the pandemic, we’ll still be seeing the impacts that Covid-19 has had on cancer. I’ve seen an estimate that there will be around 10,000 additional deaths from breast and colon cancer over the next 10 years because of missed screenings. That’s just an estimate, and it was taken pretty early on in the pandemic. I’m really hoping that we’ve caught up somewhat. 

What exactly is a cancer screening versus a diagnostic test?

The definition of a screening test is one that’s done for somebody that doesn’t have any symptoms. When someone has symptoms, so in the case of colorectal cancer that might be bleeding, blood in the stool, or bowel changes, then that would automatically lead to a diagnostic test. A diagnostic test is done to look for a cause of a problem, where a screening test is always done on an asymptomatic person to potentially find a problem before it starts. 

If you’re showing any symptoms, tell your doctor, because you will likely need a test done regardless of your screening interval. So if somebody wasn’t due for a colorectal cancer screening for another year but they were experiencing rectal bleeding, they should be tested immediately. 

Can you tell us a little bit about different screening options? 

When I talk to patients about colon cancer screening, I first assess the risk of colon cancer. People who are considered to be at higher risk are anybody that’s had a history of polyps, a family history of colon cancer, or has had any bowel changes or symptoms that could suggest a bowel issue. 

One option and the preferred option for high risk people is a colonoscopy. These screenings are not only diagnostic, they can also be therapeutic. So if there is a polyp that is seen on a colonoscopy, it can be removed at the time of the colonoscopy and sent in to be checked to see if it is precancerous.

If a patient does not have any risk factors that would place them in the high risk category, they’re probably at average risk for colorectal cancer. Colonoscopies are not the only option for screening average risk patients. One at home option is Cologuard®. It’s for people 45+ at average risk for colorectal cancer. It’s a simple stool test where a patient collects their stool from the comfort of their own home and then sends it back to be processed. The sample is analyzed for blood and DNA fragments that can be associated with cancer. It’s an effective way to screen for cancer, particularly for people who don’t have time or are uncomfortable with the idea of coming into the hospital. Patients with a positive Cologuard test result should be referred for a follow-up colonoscopy. Depending on the patient’s insurance, there may be a cost share for the follow-up colonoscopy for any stool-based screening tests.

As a healthcare provider, have you seen an increase in the number of people that have requested to use Cologuard since the start of the pandemic? 

Yes— I think people are much more open to Cologuard as a screening option. Since the start of the pandemic, many people have been hesitant to go into the doctor’s office for in-person screenings, because they think going into a hospital might increase their chances of Covid-19 exposure. We are so used to doing things from home now, between school and work and meetings and everything else. People have become much more open to telemedicine and home testing in general. Anything that can be done from the comfort of home these days seems to be of interest. 

When I discuss what colorectal cancer screening options are with my patients, a lot of times people will say, “Oh, I’ll just wait until after the pandemic and then I’ll get a colonoscopy.” I always push these patients to try to pick whatever option that they’re comfortable with doing now, because as we all love to say, “the best test is the test that gets done.” Cologuard is a good screening option for those 45+ at average risk that are worried about exposure. I also try to really reassure patients that we are doing everything we can at the hospital and in my office to make sure it’s safe and clean, so that the risk of Covid-19 exposure is really minimal. 

We know that family history is a big factor when it comes to colorectal cancer. What does that mean when it comes to screenings? 

Usually the rule of thumb is to get screened 10 years before a first degree relative was diagnosed. So if a first degree relative, meaning either of your parents or a sibling, was diagnosed at age 45, you are high risk and should get screened at age 35.

If it’s a second degree relative, like an aunt, uncle or cousin, the guidelines are less clear. Guidance might also change if you have multiple second degree relatives who have had colorectal cancer. Sometimes I’ll send people for genetic testing to see if they have a familial predisposition, but colorectal cancer is so common that many people have a relative who has had it. That doesn’t always mean those people are at a higher risk than the general population. Really what’s most important is to make sure to get screened regularly, look out for any symptoms, and talk to your doctor about your family history. 

What do you have to say to anyone who has put off a screening?

The bottom line is that cancers don’t stop just because our attention is elsewhere. Even though Covid-19 is a concern, it doesn’t mean that cancer cells will stop growing. We can’t ignore that. We’re still behind on cancer screenings since this pandemic started. I urge patients not to put off screenings any longer. Talk to your doctor about your screening options, there is really no excuse to put it off. To physicians, I would say please talk to your patients about all of the ways to get screened. Patients need to know about all of their options, so they can pick something that they are willing to do now.

You can learn more about colorectal cancer and your screening options here. When it comes to colorectal cancer screening, the best test is the one that gets done. Guidelines recommend several colon cancer screening options for average risk patients, including stool- based tests. If you are 45 and older and at average risk for colon cancer, talk to your doctor to see if Cologuard may be right for you. Rx only. See Cologuard.com for Important Risk Information.