Screenings and Prevention | City of Hope

As cancer screenings plummet, physicians urge vigilance

With many Americans staying at home to help flatten the curve of the coronavirus’s spread, non-urgent medical visits are down dramatically. One report showed that in March 2020, routine screenings for cancer were down as much as 94% compared to the previous average.
Indeed, starting in April, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, Susan G. Komen for the Cure and others issued guidelines suggesting that people postpone cancer screenings that require clinic visits. Meanwhile, the American Cancer Society (ACS) emphasized the importance of consulting with a medical professional about this issue.
By June, cancer screening rates had risen, but were still down 29% to 36% from pre-pandemic levels, according to the ACS.
As a result of delayed screenings and treatment, the National Cancer Institute has estimated a 1% increase in deaths from breast and colorectal cancer over the next 10 years, or approximately 10,000 excess deaths.
With coronavirus infections now rampant in many parts of the country, you may be wondering what the best approach is for early detection of cancer. Asked about their recommendations for screening during the COVID-19 pandemic, two City of Hope physicians who treat common cancers echoed the ACS’s recommendation, underlining that there is no one-size-fits-all answer.
Lily Lai, M.D., associate clinical professor of surgical oncology and chair of City of Hope’s Clinical Cancer Committee, urges an individualized approach.
“There has to be some risk stratification,” said Lai, who treats breast and colon cancers. “Depending on your cancer risk, you have to judge that against the risk of being exposed to COVID-19 by being outside your home.”

Who Needs to Be Screened?

Lai noted that healthy people with no symptoms and no factors that increase the chances of developing cancer can safely defer screening for the time being. However, there are categories of patients who ought to keep to their testing schedule or, at most, space out visits a little bit.
For instance, certain circumstances make an in-person trip to the dermatologist too important to put off:
  • diagnoses that increase risk for skin cancer such as myelodysplastic syndrome, chronic lymphocytic leukemia or graft-versus-host disease
  • excessive sun exposure
  • family history of skin cancer
Lai similarly identified factors that should drive a person to keep up their colon cancer screening regimen:
  • family history of colon cancer
  • risk for polyps that could develop into colon cancer
  • conditions that increase risk such as inflammatory bowel disease
More broadly, a personal or family history with any type of cancer that’s subject to screening is a good reason to visit the doctor’s office on schedule, regardless of the pandemic.

What Can Be Done from Home?

The housebound do have early-detection options for certain cancers.
  • For colon cancer, there are at-home tests — the fecal occult blood test and the fecal DNA test — that involve collecting a stool sample and sending it to a lab.
  • For skin cancer, you can perform a careful monthly inspection with the help of a partner who checks places that you can’t see on your own, such as the scalp, the back and behind the ears.

Which Symptoms Shouldn’t Be Ignored?

Some signs of disease are so significant that, should you notice them, you need to consult with your physician as soon as possible:
  • Skin cancer: new lesions that don’t go away or grow in size, changes to existing lesions or extensive rashes
  • Breast cancer: a new lump or breast mass, bloody discharge from the nipple or changes to the skin of the breast such as redness
  • Colon cancer: changes in bowel habits, including blood in the stool
  • Lung cancer: a new cough, an increasingly productive cough, shortness of breath or excessive fatigue (some of the same symptoms associated with COVID-19)

Just How Important Is Cancer Screening?

The physicians advocate that, when a “new normal” begins to assert itself, people get back on track with their routine cancer screenings.
Lily Lau Lai, Surgical Oncologist
Lily Lai, M.D.
As this acute phase of the outbreak wanes and more services reopen, you should find out when your primary physician’s office is back to offering routine physical exams and screenings such as mammograms and colonoscopies.
Doing so can make a tremendous difference.
“Screening does save lives,” Lai said. “Early detection results in cancers that can be treated and patients that can be cured. The data — especially for breast and colon cancers — demonstrates that pretty strongly."
The doctors also note that, as a center dedicated only to cancer and diabetes, City of Hope is uniquely positioned to provide clinical care during the COVID-19 pandemic. While other hospitals are delaying screenings, surgeries and other procedures, City of Hope is continuing to provide world-class care in a safe environment.
Lai continued, “The world order can change, but there are some things that remain immutable, such as the need to take care of yourself and your body, which includes screening for cancer.”