Emile Auguste Jr., a 64-year-old mortgage banker from Monrovia, California, has no qualms about maintaining his regular colorectal cancer screenings in the current COVID-19-altered environment.
“Concerns? Not for me!” he said.
Despite having many relatives with cancer, Auguste had never gone in for a colonoscopy until early 2020, when he began experiencing abdominal pain. Diagnosed with colon cancer, he needed surgery to remove 9 inches of his large intestine where the cancer had created a blockage.
Now he heads to City of Hope — by himself because no visitors are allowed — every 90 days for a follow-up visit, and he’ll need annual colonoscopies for the foreseeable future. He doesn’t worry about exposure to the coronavirus. Keeping tabs on his medical condition is too important.
“I can understand some people’s fears,” he said. “But I think you’re more at risk not knowing. And City of Hope does a great job keeping you safe.”
People’s fears, however, do persist.
City of Hope physicians saw those declines and scrambled to address them.
“There was a six-to-eight-week period where my outpatient clinical practice shifted to almost exclusively telehealth visits, and we performed only urgent and emergent endoscopic procedures,” said Trilokesh Kidambi, M.D., director of the colon cancer screening program at City of Hope. “Screening exams were all rescheduled to a later time as we sought to understand the risk to patients and providers while considering scarce resource utilization.”
“My practice changed during the pandemic,” added lung cancer surgeon Dan J. Raz, M.D., M.A.S. “Initially we saw a decline in screenings during the first six months, not just here but nationally.”
“We are seeing more patients presenting with larger breast cancers or involving nodes,” said breast cancer surgeon Laura Kruper, M.D., M.S., “probably due to lack of screening.”
“I have found colon cancers in patients with symptoms that began early in the pandemic who waited to get their procedures,” added Kidambi.
Now the fear is that the Omicron variant will scare people all over again and keep them away even longer.
“I saw things turning around before the Delta variant,” said prostate cancer specialist Clayton S. Lau, M.D., the Pauline & Martin Collins Family Chair in Urology. “People were coming back.” Now the highly contagious Omicron variant has complicated things even further.
Human nature may have the last word. “People will avoid elective procedures whenever they see a surge [in the virus],” Raz said.
Screening Guidelines
If you’re generally healthy and have no symptoms, screenings help you stay that way. Accordingly, the Centers for Disease Control and Prevention strongly supports regular screenings — virus or no virus — for colon, breast and cervical cancer. (Ages and frequency guidelines vary.) The CDC adds lung cancer screening to that list (generally an annual computed tomography scan of the chest) if you’re a heavy smoker or smoked in the past and quit. The agency is less adamant about other screenings for asymptomatic people. Nevertheless, Lau and others point out that a significant number of prostate cancers (which normally grow slowly) can be aggressive and dangerous. He recommends annual blood tests to stay current with your PSA (prostate specific antigen) score and taking note of any abrupt changes.
For now, though, the surest way to overcome fear of COVID-19 exposure is to understand how well your medical facility guards against the coronavirus. From the start, City of Hope instituted strict protocols that minimized COVID-19 transmission and kept everyone safe. “I feel confident,” stressed Raz, “that you face less risk at City of Hope than you do going to the supermarket.”
As a cancer survivor, Auguste feels all of this more acutely than most. And he has an additional reason to urge everyone to continue their screenings. In one of his follow-up visits, doctors detected a previously unknown case of high blood pressure — serious, but treatable. “That visit saved me!” he said.
“By getting screened,” he added, “you help maintain your health, for your sake and the sake of your family, your kids who look up to you. You can set an example.
“Why wouldn’t you want to do that?”