Many people skipped or delayed routine cancer screening tests during the early months of the coronavirus pandemic. Medical providers say it’s now safe and prudent to schedule your appointments.
“If you put off your cancer screening mammograms or other screening procedures, we encourage you to reschedule them now,” says Craig Bunnell, MD, MPH, Dana-Farber’s chief medical officer.
Since everyone’s medical situation is unique, experts recommend talking to your doctor or care team to discuss what’s best for you.
Routine screening tests include mammograms to detect breast cancer, Pap tests for abnormalities that could lead to cervical cancer, colonoscopies to find early signs of colorectal cancer, and imaging scans for lung cancer in people with a history of heavy smoking. Short-term delays in these tests aren’t a reason to panic, but long-term delays may have an effect on health outcomes.
Although the pandemic is not over, measures have been put in place in doctors’ offices, clinics, and hospitals to protect individuals while they are being screened. At Dana-Farber, these safeguards include:
- Masks to be worn by all patients and staff
- Plexiglass barriers
- Physical distancing
- Intensified deep cleaning
- Hand sanitizer stations
- Marked places to stand in elevators
- Limits on the number of people in common areas
Harold Burstein, MD, PhD, a breast oncologist at Dana-Farber, says that mammograms are an important part of health care for women, and although they were interrupted by the COVID-19 pandemic, they can now be carried out at Dana-Farber.
For most women, a one-time delay of six to 12 months in mammogram scheduling should be of no clinical consequence, Burstein says. However, women who have concerns about changes in their breast, or who are at high risk for developing breast cancer, should make a more concerted effort to return to routine screening sooner rather than later.
Factors that increase a woman’s risk of breast cancer include:
- Older age
- A family or personal history of the disease
- An inherited mutation in a BRCA1 or BRCA2 gene
- Being overweight or obese
- Having a first child after age 30 or not having had a full-term pregnancy
- Dense breasts
Additionally, if you notice any suspicious changes in your breast(s), you should alert your doctors, who will order prompt evaluation.
Colonoscopies — which involve examination of the colon using an endoscopic device that enables physicians to detect tumors or pre-cancerous polyps — are recommended beginning between age 45-50 for men and women who are at average risk.
Routine colonoscopies were delayed in early 2020 by the coronavirus pandemic, but now the American Gastroenterological Association says that they can be resumed when there has been a sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days.
“Higher-risk patients especially should consider screening in upcoming months,” says Jeffrey Meyerhardt, MD, MPH, clinical director of the Gastrointestinal Cancer Center at Dana-Farber. “Average-risk patients should also consider setting up colonoscopies in the fall.”
Higher-risk patients would include people with a known predisposition to colorectal cancer, such as:
- People with Lynch syndrome
- Individuals with a history of ulcerative colitis or Crohn’s disease
- A family or personal history of colorectal cancer or colorectal polyps
Anyone with symptoms such as bleeding, a change in bowel habits, change in caliber of the stool, or bloating, should also speak immediately with a physician about getting a colonoscopy.
Pap tests, which collect cells at the opening of the cervix, are recommended for women beginning around age 21 and continuing until age 65. The test can reveal abnormalities indicating pre-cancerous or cancerous cervical lesions. Guidelines on frequency vary from every three to every five years.
Increased risk for cervical cancer is caused by:
- Infection with the human papillomavirus (HPV)
- Sexual activity beginning at a young age
- Chlamydia infection
- A family or personal history of cervical cancer.
Lung cancer screening
Lung cancer screening, which uses low-dose CT scans of the lungs, is aimed at detecting cancer at very early stage when it’s more likely to be cured. It is recommended for older adults who are longtime smokers and who don’t have any signs or symptoms of lung cancer. The screening is generally offered to smokers and former smokers who are 55 and older, and who have smoked heavily for many years.
Prostate cancer screening
Before you undergo screening for prostate cancer, it is important to have a conversation with your health care provider. They can inform you about the potential benefits and uncertainties of prostate cancer screening, which can be more complicated than screening for other cancers.
Prostate cancer that is diagnosed as a result of screening will likely be at an earlier, more treatable stage, which sounds positive. It often is. Prostate cancer screening is capable of finding dangerous disease when it is confined to the prostate gland and still curable.
However, prostate cancer screening has two potential negative consequences:
- First, the screening tests themselves (primarily, prostatic-specific antigen, or PSA, test) do not only measure cancer. PSA is also produced by normal prostate tissue. An elevated PSA may reflect the normal growth of the prostate that occurs to some extent in all men as they age. This creates seemingly “abnormal” results when the individual does not have cancer, in turn leading to unnecessary procedures and stress.
- Secondly, many prostate cancers are very slow growing and are incapable of threatening an individual over the course of his lifetime. There prostate cancers do not need to be detected. Finding them via prostate cancer screening may lead to unnecessary, even life-altering, medical procedures.
Different organizations have varying recommendations for prostate cancer screenings, which reinforces the importance of speaking with your doctor about what the best option is for you.
- The U.S. Preventive Services Task Force (USPSTF) recommends against PSA-based screenings in men older than 70. For those between 55 to 69 years old, the decision to undergo a PSA test should be made on a case-by-case basis after discussion with a primary care physician or urologist.
- The American Cancer Society (ACS) recommends screenings begin at the following intervals, only if a patient agrees to it after having an informed consultation with a licensed healthcare provider:
- Age 50 for those who are at an average risk and are expected to live at least 10 more years.
- Age 45 for individuals at a high risk, including African Americans and men with a first-degree relative diagnosed with prostate cancer at an early age (younger than 65).
- Age 40 for those at an even high risk meaning they have more than one first-degree relative who had prostate cancer at an early age.