CORONAVIRUS

Iowa doctors see delays in cancer screenings during pandemic, delaying diagnoses, treatment

Cedar Rapids oncologists expect to catch up on missed screenings by year's end

A surgeon directs a special camera to be able to view his patient's cancer tumor on monitors while performing surgery at
A surgeon directs a special camera to be able to view his patient’s cancer tumor on monitors while performing surgery at a hospital in Philadelphia in this 2018 photo. As the COVID-19 coronavirus spread, many cancer surgeries were delayed, stent procedures for clogged arteries had been pushed back and infertility specialists were asked to postpone helping patients get pregnant. (Associated Press)
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Cancer screenings nationwide dropped this year in part due to efforts meant to prevent the spread of COVID-19, prompting concern among local providers that patients are sicker as a result of the pandemic.

Fears among local oncologists — expressed as early as April — that patients’ delay in screenings would result in less diagnoses seem to be coming true in recent weeks.

As health care providers work to resume care that was delayed because of the pandemic, Cedar Rapids-based oncologists are finding fewer patients are being diagnosed with cancers commonly spotted through routine screenings, such as mammograms and colonoscopies.

And it’s not that diseases are occurring at a lower rate. According to local providers, the patients they are seeing have been diagnosed with a more progressed stage of those diseases.

“Everything starts with the screening. A delay in cancer screening means a delay in diagnosis means a delay in definitive treatment,” said Dr. Vincent Reid, surgical oncologist and medical director of Mercy Medical Center’s Hall Perrine Cancer Center. “It’s all related.”

Similar concerns that the novel coronavirus may have deterred patients from seeking necessary care have been voiced across the medical field for the past several months, including those experiencing heart attack or stroke symptoms.

“COVID-19 put up one more barrier to getting help. Sometimes it only takes one small thing for a person to put off care,” said Dr. William Fusselman, a hematology and oncology specialist with UnityPoint Health-Cedar Rapids and Physicians’ Clinic of Iowa.

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As hospitals shut down elective surgeries in an effort to preserve personal protective gear and prevent transmission of COVID-19, colonoscopies were put on hold for several weeks throughout March and April.

Breast cancer screenings also stopped entirely at Mercy Medical Center between March 15 and April 30 due to COVID-19.

Before that period, Mercy Medical had seen a small increase in patient volumes in the early part of 2020 when compared to the previous year, according to hospital data.

February, for example, saw an 8 percent increase in patients when compared to the same month in 2019.

Mammograms and breast exams at UnityPoint Health-Cedar Rapids dropped 60 percent in March, April and May of this year when compared to 2019, according to Fusselman.

Nationwide, routine screenings for breast and colorectal cancers dropped as much as 80 percent in April 2020, according to one study in a journal published by the American Society of Clinical Oncology.

Other studies suggest this trend ties back to the recent drop in overall cancer diagnoses seen across the United States.

An August study in the Journal of the American Medical Association found new diagnoses for six types of cancers — including breast and colorectal cancers — dropped 46 percent in March and April 2020 when compared to rates from previous years.

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Local providers expect to make up routine screenings that were missed in the spring by the end of the year, Fusselman said.

Some Cedar Rapids oncologists still worry that the patients’ diseases will be more progressed.

Physicians won’t know for sure until more data is available, Reid said, but has seen anecdotes that suggest it may be the case.

For example, his team has seen more breast cancer cases that are more advanced stages.

It’s hard to tell if that means patients will have worse outcomes in the long-term, Fusselman said, but added he “would not be surprised” if doctors see excessive mortalities among cancer patients.

One national study also suggests the same. According to the study published in the Journal of the American Medical Association, the United States could see an increase of nearly 34,000 excess deaths. That’s in addition to cancer-related deaths typically seen nationwide.

But Fusselman said he is optimistic no one is delaying treatment anymore due to fear of the pandemic.

“The mood has changed, and people are more comfortable with (coronavirus) precautions and are more comfortable going to the hospital,” Fusselman said.

“I have not heard people more recently delaying that care.”

Both Reid and Fusselman emphasized the importance of patients seeking out these routine screenings, and to check with their doctor if they experience any abnormal symptoms.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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