As we continue to cope with the ongoing coronavirus pandemic nationwide, a second public health crisis is emerging and causing increasing alarm. Stemming from the initial deferrals of routine care as the pandemic took hold, combined with shelter-in-place health orders and the fears generated by early reports of overflowing hospitals, people across the country have stopped coming in for routine cancer screenings. The result, for thousands of patients, could be disastrous.
Over the past 10 years, we have made tremendous gains in terms of reduced cancer deaths, thanks to screening, prevention, and early detection. We are now at risk of reversing that progress, as many patients forgo standard screening, such as colonoscopies, mammograms and pap smears, leading to delays in diagnosis and subsequent treatment of cancer.
NIH's National Cancer Institute is projecting that an additional 10,000 people in the United States will die from colorectal and breast cancer in the coming decade because their cancers will be detected at a later stage. Timely diagnosis and prompt initiation of treatment is critical to ensure optimal outcomes for most tumor types. This is not limited to the U.S. In a recent study, researchers in the UK estimated that there will be an increase in deaths due to cancer at five years after diagnosis for lung, breast, esophageal and colorectal cancer. The increase ranged from 4.8% for lung cancer to 16.6% for colorectal cancer.
We can only assume that these estimates will apply to many other cancers and because they are already disproportionately affected will ultimately hit minority and underserved populations especially hard.
This doesn't need to happen. When the coronavirus developed into a pandemic in late winter, most healthcare providers around the country rightly suspended all non-urgent medical care while we implemented procedures to keep patients and medical staff safe. The learning curve was abrupt and steep. However, in the five months since the shutdown, the medical community has learned a great deal and has developed systems that make it safe for patients to return for every level of care, even as the coronavirus looks to be surging in many places.
At UCSF, we have successfully implemented telehealth as a way to treat many patients with- or at risk for cancer. This happens online or on the telephone. Should patients need to visit in person, we have strict mask policies for all employees and patients at every care site. Second, all employees and patients are required to take screening tests before entering our facilities. Anyone with symptoms for the coronavirus is treated in isolation away from others. Finally, we are following stringent cleaning and distancing guidelines developed by the CDC.
It is likely that we will experience the ebb and flow of the coronavirus for many months. However, it's critical that people pay attention to their general health, and this includes essential annual screenings, as well as addressing new symptoms. Essential screenings, preventive care and follow-up care should not be delayed further.
Decisions about restarting screening depend on many factors, and they may not be the same for every person. Some important things to consider include your risk of getting a certain type of cancer, how long it's been since you were last screened for it, how common the coronavirus is in your community, and your age and overall health.
Talk to your health care provider about the risks and benefits for you of being screened now, and do the same for loved ones. It is critical to remember that most diseases are treated more successfully the earlier they are detected. It is essential, even in the face of the pandemic, not to delay important screening and care.
Laura E. Crocitto is vice president and chief medical officer for cancer services at UCSF Health.