Will COVID-19’s impact on cancer screening mean people are diagnosed with more advanced cancers?

Will COVID-19’s impact on cancer screening mean people are diagnosed with more advanced cancers?

1 in 28 South African women at risk of breast cancer

Over the course of the COVID-19 pandemic, there’s been a decline in people sticking to routine and scheduled cancer screening checks - like mammograms for breast cancer, pap smears for cervical cancer, PSA blood tests and examinations for prostate cancer, colonoscopies for colon cancer and so on.

Dr Noluthando Nematswerani, Head of Discovery Health’s Centre for Clinical Excellence says, “This global trend – which we also see play out among members of medical schemes administered by Discovery Health - is really concerning. This October – Global Breast Cancer Awareness Month - let’s convey the importance of breast cancer screening and make that a gateway into reminding people that screening for cancers is a must,” adds Dr Nematswerani.

Louise Turner, Chief Operations Officer at the Breast Health Foundation (an organisation which consists of a team of breast cancer survivors, supported by the Discovery Fund) adds, “Breast cancer is one of the most common cancers in women worldwide. In fact, in South Africa, the prevalence is high, with 1 in 28 women at risk of breast cancer. All in all, early detection saves lives. We’ve seen women presenting with severe and advanced breast cancers this year, due to a lack of cancer screening in 2020.”

Dr Nematswerani adds: “Missed cancer screening checks mean a missed opportunity to catch any signs of cancer as early as possible. That’s because cancers that are picked up late are harder to treat.”

“These screening tests should take place annually or every two to three years, depending on one’s cancer risk profile. Routine cancer screening is really important in catching cancers early on, as it allows for timely management. This is the most effective way to deal with all cancers,” adds Dr Nematswerani. “Cancer progresses – and is classified in stages, with earlier and more localised disease being more amenable to complete removal and long-term survival.”

What’s prevented people from sticking to screening schedules over the past two years?

“Contributing factors, include stay-at-home measures and their effect on people’s likelihoods to see their doctor,” says Dr Nematswerani. “Then we have possible screening site closures or temporary suspension of cancer screening services at times, due to COVID-19. At the same time, throughout the pandemic, people have worried about their risk of exposure to COVID-19 at healthcare facilities, so stayed away from their doctors. And during waves of infections, healthcare facilities have been under pressure to allocate and re-direct available personnel and resources towards COVID-19 related care. All in all, we’re dealing with the aftermath of a perfect storm of factors.”

“We are working hard to reverse the collateral damage of the pandemic on cancer screening checks and on other checks such as for blood pressure, blood sugar, cholesterol and other indicators of the onset of chronic illness.”

17% drop in breast cancer screening; 18% drop in cervical cancer screening

“We are concerned about the impact of delayed cancer diagnosis and initiation of treatment on members’ quality of life and prognosis as well as on costs of their care.”

When it comes to breast cancer incidence in the Discovery Health administered medical scheme member base, there has been a 17% decrease in mammography visits from 2018 to 2020 (year-on-year comparison, per 1000 medical scheme member lives), due to the pandemic. “The lowest screening rates were seen in April 2020, showing the link between these trends and onset of lockdown periods in South Africa.”

Similarly, Discovery Health has observed an 18% decrease in Pap smears from 2018 to 2020. Pap smears detect abnormal cells in the cervix before they lead to cervical cancer.

Screening for breast cancer is key to preventing late-stage cancer

“Women should understand how to do breast self-examinations and stick to a regular monthly routine so any lumps or changes in the breast can be detected early for better outcomes. And, any lumps anywhere else in the body should also be assessed by a healthcare provider soonest. Today’s medical technologies will easily detect cancers even where people have no signs or symptoms of disease, so really are the best and only way to catch cancer early on.”

When it comes to breast self-examinations, Turner says 70% of all breast cancer is found through self-checking, so it’s a really important exercise, and within that group 60% of cases are found by our partners, who sometimes know our bodies better than we do.”

She explains the process of breast self-examination as follows:

• Conduct a self-examination once a month. For younger women, do the check seven days after your period. Women in menopause should choose a day of the month and stick to that day.
• You can stand up or lie down, in the shower or wherever its easier. But do the same thing every month so changes are easy to pick up.
• Take three fingers and gently massage the breast to look for any lumps or bumps. Go in any direction – up, down, circular but cover the whole breast (without squeezing the nipple). Also go under your arm and look for enlarged lymph nodes and proceed all the way from there to under your neck and up to your ear - on each side. The lymphatic system runs from the middle of your chest to your ear.

Also check for:

• - The skin around the breast wrinkling or puckering
• Change in the skin around the nipple or itching of the nipple
• Inverted nipple or spontaneous discharge
• One breast suddenly becoming bigger than the other
• Swollen glands in the armpit
• Specific areas of pain or tenderness

“If anything changes see your doctor to assess things further,” says Turner. “Mammograms and ultrasounds are done together as part of standard routine screening and your doctor will decide whether you need an MRI – for a more in-depth view of what is happening in the breast.”

• Ultrasounds can be done from your twenties.
• Mammograms from the age of 40. If you have a family history of breast cancer, start your screening tests at ten years younger than the person who had cancer in your family was, when diagnosed.

“13% decrease in oncology registrations for Discovery Health Medical Scheme (DHMS)”

Discovery Health has also recorded a 13% overall decrease in oncology registrations to the Discovery Health Medical Scheme Oncology Benefit between June 2019 and June 2020. “This means that fewer people are being diagnosed with cancer,” says Dr Nematswerani. “The figure reflects a reduction in screening checks and, a decrease in cancer diagnoses mainly achieved through elective surgical procedures that were deprioritised during the pandemic.:

“Fortunately, where medical scheme members were already receiving cancer care, the continuity of care was not impacted by the pandemic as oncology units took the necessary steps and precautions to ensure that members continued to access treatment.”

“The take-home message in this discussion is that regular cancer screening is so important. Short delays in accessing cancer screening are perhaps possible to accept, but long delays are really not acceptable,” concludes Dr Nematswerani.