Americans Are Reckoning With Repercussions of Missed Cancer Screenings

Mammograms, colonoscopies, Pap smears, prostate exams, and other tests that look for early signs of cancer fell by the wayside during the pandemic. Now, experts are able to quantify just how steep screenings actually declined.

“Early reports suggested cancer screening dropped by more than 90% for some cancer screening tests,” Laura Makaroff, DO, senior vice president for prevention and early detection for the American Cancer Society, told Verywell.

For some, the fear of contracting COVID—especially before vaccines became available—kept them at home as much as possible. For others, pandemic precautions shuttered access to their regular providers and any other healthcare services that weren’t an emergency.

While forgoing preventive care was justified or unavoidable in these circumstances, it wasn’t without consequence.

More advanced cancers might be easier to spot, but they’re often harder to treat and, for many, will ultimately be fatal.

In June 2020, Norman E. Sharpless, MD, at that time the director of the National Cancer Institute, estimated that there would be 10,000 excess deaths by 2030 attributed to breast cancer and colorectal cancer alone. That was about a 1% increase in deaths from the two types of cancer.

‘Don’t Put It Off—No Matter What’

When the Boston area shut down in April 2020, Helen Epstein of Lexington, MA, had other things on her mind besides the COVID pandemic.

Epstein, a journalist and author, had just published a book, but COVID-19 put a stop to her book tour plans.

It also put a stop to Epstein’s normal healthcare plans. At the age of 73, she was in overall good health. However, she had a history of fibroid tumors in her uterus and had also been on hormone replacement therapy for several years.

Knowing that these factors put her at a higher risk for uterine cancer, she had pelvic ultrasounds every few years just to keep an eye on things.

Epstein had already put off having her regular pelvic ultrasound a couple of times, and she put it off again during the pandemic.

Then, in late May 2020, she saw a streak of blood in her underwear.  

“I’m not a health reporter, but I knew enough to know that postmenopausal women should not have a streak of blood in their panties,” Epstein told Verywell.

Her gynecologist immediately ordered a pelvic ultrasound that showed that the lining of her uterus was thicker than it should have been. A biopsy of her endometrial lining done in early June led to a diagnosis of endometrial cancer.

Epstein’s gynecologist referred her to Annekathryn Goodman, MD, a gynecologic oncologist and surgeon at Massachusetts General Hospital.

If there was a small silver lining to the pandemic for Epstein, it was that because other people were postponing elective surgeries, she was able to get an appointment for the needed surgery almost immediately.

Epstein underwent a total hysterectomy in late June, followed by brachytherapy, a type of radiation treatment, and chemotherapy in July. Even though she’s now cancer-free, Epstein still regrets having delayed her cancer screening.

“My message to everyone would be ‘Don’t put it off no matter what,’” said Epstein. “Get your screening.”

Epstein’s story had a happy ending—she even wrote a book: “Getting Through It: My Year of Cancer During Covid.”

People Are Still Skipping Screenings

While pandemic restrictions have started to ease up, the number of people having their cancer screenings still hasn’t gone back to pre-pandemic levels.

Makaroff pointed to a recent study of the Return-to-Screening program created by the American College of Surgeons Cancer Programs and the American Cancer Society. The study noted screening decreases that extended through mid-2021.

Nearly 750 accredited cancer programs in the United States enrolled in the study within a few weeks of its start in 2021.

According to Heidi Nelson, MD, the medical director of the American College of Surgeons Cancer Programs, most of these programs reported nationwide screening deficits in 2021.

To help reverse the trend, the American Cancer Society and the American College of Surgeons Cancer Programs have created a joint initiative intended to get cancer screenings in the U.S. back on track. The organizations are communicating with business, local governments, and advocacy groups to determine what materials and interventions clinics actually need to boost screenings.

In the meantime, experts say they still don’t have a full picture of what the lack of screenings meant for cancer deaths.

“While we are closely watching cancer screening rates across the country, what we ultimately care about is cancer incidence and mortality,” said Makaroff. “It will take time to see what the long-term impact of the pandemic is and probably several years before we have a more comprehensive understanding.”

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