Doctors warn that diagnosis will be delayed as the backlog of cancer screening increases

According to cancer professionals across Canada, patients may need special encouragement to attend regular cancer screening appointments.

Last year, many cancer services were suspended during the first wave of the COVID-19 pandemic. Most have resumed in the summer, but doctors are concerned that regular cancer screenings have not yet recovered from the slowdown.

Dr. Jonathan Irish, head of the Department of Surgical Oncology at Cancer Care Ontario and Ontario Health, said the health system could face a “tsunami” in patients whose diagnosis and treatment were delayed by a pandemic. “Collateral damage to COVID-19 in many areas will be significant.”

In Ontario alone, hundreds of thousands of people missed regular cancer screening appointments last year.

During the first few months of the pandemic, screening mammograms decreased by 97%, Papanicolaou trials decreased by 88%, and fecal blood tests for colon cancer screening decreased by 73%, according to Irish people.

In the case of mammogram screening, service interruptions resulted in a shortage of more than 152,000 screens between March 15, 2020 and May 31, 2020 compared to the previous year. By December, the backlog had doubled and more than 300,000 screening mammograms were missed. That number may be higher than it is now. State officials say screening was also affected during the third wave and could be scaled down depending on local resources.

In other states, the number of new cancer diagnoses has declined since the pandemic began, suggesting that some cancers may not be detected.

Earlier this year, Quebec officials estimated that 4,119 cancer patients were undiagnosed during the first wave of COVID-19.

According to Dr. Colin Mar, Medical Director of BC Cancer Breast Screening, the number of cancers clinically detected by symptoms and tests has “returned to near normal” in British Columbia. However, the number of cancers detected by screening has not yet returned to pre-pandemic levels, as participation in screening remains lower than normal.

“We are trying to encourage people to come back,” says March. The screening program has strengthened COVID-19 safety measures, including scheduling intervals. Among patients, “Safety concerns still remain, but our lives are also severely shaken … people had to re-prioritize things.”

In Ontario, cancer screening capabilities and participation have declined and flowed with the pandemic, said Dr. Keith Stewart, vice president of cancer services at the University Health Network in Toronto.

“When the pandemic blockade level goes up, programs that detect cancer fail,” Stewart says. “A little later, I noticed a referral and reduced radiation, especially the cancers detected by screening (breast cancer, colon cancer, cervical cancer).”

Patients have still received letters recommending screening, but Stewart states that the amount of people to follow up is “not where it should be.”

“Maybe you’re saying,’I’m blocked. I can’t go out.’ Or maybe I don’t want to be around people, or I don’t have a caregiver to come with.” There is, “says Stewart.

Thunderbay’s screening service has launched a campaign to encourage people to be screened for breast, cervical and colon cancer, warning that “cancer does not stop at COVID-19.”

Catch-up screening may also be required to clear the scheduled backlog. A study published in The Lancet Gastroenterology & Hepatology found that without catch-up efforts, even if screening for colorectal cancer was interrupted for three months, hundreds more could die in the next 30 years.

Medical services can reduce the screening backlog by temporarily expanding capacity. However, according to The Lancet Public Health’s commentary, key components of screening programs such as cytology and colposcopy require a skilled workforce that cannot grow quickly and may force burnout, forcing overtime. That is not realistic. Therefore, performing catch-up screening on people at the highest risk of cancer may be “the most effective way for screening services to recover.”

Currently, Stewart predicts that it may take a long time for the healthcare system to catch up. “Even if it returns to 100%, it will be a few years.”