Since March of 2020, the COVID-19 pandemic has profoundly impacted every aspect of our lives, including how primary physicians care for their patients. Due to the ongoing restrictions over the last fifteen months and fear of contracting COVID-19, many patients have been hesitant to meet with their family doctor regarding their health. One area in particular that the pandemic has severely impacted is cancer screening.
Cancer screening was halted altogether in April and May 2020 and volumes were significantly reduced for much of 2020 and even 2021. As a result, cervical and breast screening rates have significantly decreased from 2019. The ease of administering FIT tests at home has helped colon cancer screening rates remain fairly consistent over this same time frame.
The decrease in screening volumes was reflected downstream in decreased cancer referrals. From March to September 2020, referrals to cancer centers across the country were down by about 20%. At the same time, referrals to Ontario largest cancer centre for breast and gi cancers was down by ~40%. Annedotaly, even now, breast cancer referrals at The Ottawa Hospital Cancer Center are decreased by about 50%.
At the same time, the COVID pandemic has also caused significant backlogs in key diagnostic steps for cancer work up. As of March of this year, before the province announced the Stay-at-Home order, thirty-seven percent of individuals with a high-grade pap result were waiting for colposcopy. There is a 4 year backlog for a colonoscopy, and delays with breast biospies, imaging and surgery.
According to Dr. Anna Wilkinson, Assistant Professor in the Department of Family Medicine at the University of Ottawa, the end result of the decrease in screening and diagnostic capacity is “upstaging” of cancers. Cancers will be diagnosed at a later stage, therefore requiring more complex treatments, with resultant increased resource use, morbidity and mortality. These changes will disproportionately affect racialized and underserviced communities. Modelling has shown that show that a 3 month pause in screeing and reduced screening for two years will result in up to 100,000 life years lost. A 24 month reduction in breast cancer screening is predicted to lead to 730 additional breast cancer deaths.
Dr. Wilkinson’s message to family doctors is, “screening is open. Bring your patients in for paps, encourage FIT tests and mammograms, so that we can start to improve screening volumes, and catch cancers earlier when they are more treatable and survival is better”. At the same time, family physcians need to be mindful of resource utilisation given the significant system backlogs. Two easy examples where PCPs can conserve resources: cervical screening can be delayed until age 25 to align with new evidence; and FIT tests should be used instead of colonscopy for average risk patients. For more tips on cancer screening in the pandemic, please see the June Primary Care Cancer Connection Newsletter, and watch for the next edition coming to your email in September via the OMA which will contain updates on HPV cancer vaccination and COVID related backlogs.