While a raging pandemic continues to force shutdowns and slowdowns throughout the country, another major risk to human health is not taking a sabbatical: cancer.
In the early months of the pandemic, millions of people heeded warnings and fears about contracting the coronavirus and avoided, or couldn’t even get, in-person medical visits and cancer screenings, allowing newly developed cancers to escape detection and perhaps progress unimpeded.
During this time, there was a steep decline in screenings for cancer, as well as a reluctance of patients with cancer to participate in clinical trials for cancer treatments. Many mammography centers, dermatology offices and other venues for cancer screenings remained closed for months, and routine colonoscopies, which should be done in hospitals or surgical centers, were actively discouraged to minimize strain on medical personnel and equipment and reduce the risk of contagion.
Still, Dr. Norman E. Sharpless, director of the National Cancer Institute, warned in June that missed routine screenings could lead to 10,000 or more excess deaths from breast and colorectal cancers within the next decade.
Cancers cannot be treated unless they’re detected, and a review of 34 studies published in October in the BMJ reported that for every four-week delay in cancer detection and treatment, the risk of death from cancer rises nearly 10 percent, on average. The study found increased mortality following delays in treatment for 13 of 17 cancer types. Following a four-week delay in surgery for breast cancer, the death rate increased by 8 percent; for colorectal cancer, it rose 6 percent.
The hazard of delayed screenings is greatest for people with known risk factors for cancer: a family or personal history of the disease, a previous abnormal Pap smear, prior findings of polyps in the colon or rectum, or, in the case of breast and certain other cancers, having genetic mutations that seriously increase cancer risk.
Most screening facilities have since put safety procedures in place that greatly reduce the chance of contracting the coronavirus, both for staff and patients. Although I had postponed my annual mammogram for four months, when I did go in September I was impressed with how well the facility was run — no one else in the waiting room, everyone masked and hand sanitizer everywhere.
Dr. Barry P. Sleckman, director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, said in an interview, “When it comes to screening for cancer, people should balance the possibility of contracting the virus with their potential cancer risk. People should do everything possible to keep up with cancer screenings.”
However, Dr. Sleckman added, “If a woman is young and has no family history of breast cancer, she can probably wait six months for her next screening mammogram.” He also suggested discussing the matter with one’s personal physician, who probably also knows the safest facilities for screening.
If someone is found to have cancer, he emphasized, “There’s no reason to delay treatment. If a woman has cancer in a breast, it needs to be removed, and she should go to a hospital where she can be treated safely.”
Dr. David E. Cohn, chief medical officer at The Ohio State University Comprehensive Cancer Center, said that in the early months of the pandemic “we experienced a significant decline in new patients. Even some patients with symptoms were afraid to come in or couldn’t even see their doctors because the offices were closed. This could result in a delayed diagnosis, more complex care and potentially a worse outcome.”
But he said his center has since returned to baseline, suggesting that, despite the fall’s surge in Covid-19 cases, few cancer patients now remain undiagnosed and untreated.
“We made creative adaptations to Covid” to maximize patient safety, Dr. Cohn said in an interview. “For certain cancers, instead of doing surgery upfront, we treated patients with radiation and chemotherapy first, then did surgery later” when there was less stress on hospital facilities and personnel and patients could be better protected against the virus.
Confused by the terms about coronavirus testing? Let us help:
- Antibody: A protein produced by the immune system that can recognize and attach precisely to specific kinds of viruses, bacteria, or other invaders.
- Antibody test/serology test: A test that detects antibodies specific to the coronavirus. Antibodies begin to appear in the blood about a week after the coronavirus has infected the body. Because antibodies take so long to develop, an antibody test can’t reliably diagnose an ongoing infection. But it can identify people who have been exposed to the coronavirus in the past.
- Antigen test: This test detects bits of coronavirus proteins called antigens. Antigen tests are fast, taking as little as five minutes, but are less accurate than tests that detect genetic material from the virus.
- Coronavirus: Any virus that belongs to the Orthocoronavirinae family of viruses. The coronavirus that causes Covid-19 is known as SARS-CoV-2.
- Covid-19: The disease caused by the new coronavirus. The name is short for coronavirus disease 2019.
- Isolation and quarantine: Isolation is the separation of people who know they are sick with a contagious disease from those who are not sick. Quarantine refers to restricting the movement of people who have been exposed to a virus.
- Nasopharyngeal swab: A long, flexible stick, tipped with a soft swab, that is inserted deep into the nose to get samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be collected with swabs that do not go as deep into the nose — sometimes called nasal swabs — or oral or throat swabs.
- Polymerase Chain Reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. Tests that use PCR enable researchers to detect the coronavirus even when it is scarce.
- Viral load: The amount of virus in a person’s body. In people infected by the coronavirus, the viral load may peak before they start to show symptoms, if symptoms appear at all.
Dr. Cohn said that certain kinds of supportive care can be delivered remotely to cancer patients and their families — even genetic counseling, if a DNA sample is sent in. However, he added, “the majority of cancer treatment has to be administered in person, and surveillance of cancer patients is best done in face-to-face visits.”
Now with the virus surging around the country, many medical centers may be forced to again limit elective procedures, those not deemed urgent. But, Dr. Sleckman said, “Cancer treatment is not elective — it’s urgent and should not be delayed.”
Learning that one has cancer, even when it is early and potentially highly curable, is likely to strain a person’s ability to cope with adversity, all the more so when the diagnosis occurs in the midst of an already highly stressful and frightening pandemic.
Kristen Carpenter, a psychologist at the Ohio cancer center, said the constraints of the pandemic are “using up a lot of people’s reserve for dealing with adversity.” Adding a cancer diagnosis on top of that may initially cause people to fear they can’t deal with it, she said in an interview.
But it is nearly always possible to make more room in a person’s “bucket of reserve,” she said, for example, by identifying things that bring joy or a sense of accomplishment. Even though the pandemic may preclude great joys, Dr. Carpenter said, “people can create a constellation of smaller joys, for example, by reading a book, taking a walk or even a long shower. A little goes a long way to relieve the stresses of the day and build up the reserve needed to help you deal with the cancer.”
Noting that many people have found new ways to interact with others during the pandemic, “this is all the more important to do in the face of cancer,” Dr. Carpenter said. “Remember, you’re not just your cancer. You’re a whole person experiencing something. Take time to identify your needs and tell people what they are — don’t wait for them to ask.”
This advice is especially critical to cancer patients whose disease or treatment has compromised their immunity, leaving them especially vulnerable to infection by the coronavirus. A friend with chronic lymphoma who must avoid in-person contact with her five young grandchildren visits them through a glass door and observes their delight in retrieving the little treats she leaves for them on her porch.
Think, too, of how you’ve faced difficulties in the past, “how you’ve adapted to things you previously believed to be unimaginably difficult,” Dr. Carpenter suggested. Resiliency in the face of cancer during Covid need not have a limit, she said.