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Last spring, the calendar displayed a notice on the calendar that there were two scheduled cancer screenings. But healthy I didn’t go near the pandemic medical facility. And obviously other Americans had similar ideas. Breast, colon, and cervical cancer screening decreased by 94% in March compared to the same average over the past three years, analysis 2.7 million health records from healthcare software company Epic.
However, as the pandemic has worn down, many doctors and healthcare facilities have called back patients, Schedule appointments safely and carefullyCan delay screening, Do more harm than good By causing Dramatic spikes in undiagnosed and untreated cancer, And Screening tests can save your life.. Such appeals often affect people’s sense of responsibility and fear. Recent paper To USA Today Theresa Beavers, dean of medicine at the University of Texas MD Anderson Cancer Center, said: Die at COVID-19″
so editorial for Science Norman Sharpless, director of the National Cancer Institute, magazine numbers the potential pandemic effects on breast and colorectal cancer, which together account for about one-sixth of all cancer deaths. Occupy Sharpless says the NCI modeling project says that close to 10,000 Americans will die of these cancers over the next decade due to delays in screening and treatment.
It sounds harsh, but some critics are starting to push the screening story back, suggesting that patients aren’t getting the kind of subtlety they need. Not everyone needs screening, they say just now, And whatever the potential fallout from the skipped screen, it needs to be considered for the risk of the new coronavirus.
For example, H. Gilbert Welch, a senior investigator at the Surgery and Public Health Center at Brigham and Women’s Hospital in Boston and a long-time critic of unnecessary tests and interventions, said According to the calculations, the projected cancer excess mortality over the next decade is only a small fraction of the US COVID-19 mortality over the past six months. In addition, Welch’s NCI analysis enhances routine screening by caring for actual symptoms. “They really Really It’s different.” Women with lumps in the breast should be advised to have a diagnosis. Mammogram Welch mentioned whatever the local COVID-19 risk was. “But whether we should invite everyone else to screen and offend them is a completely different fish kettle.”
It’s safe to say that treatment can save lives, but the same may not be true for some screening tests. The unpleasant facts prolong the disagreement over who should be screened and when screening causes further problems. COVID-19 only adds another dimension to these decisions.
Welch and others who are studying the impact of screening also found that this unprecedented pause was not only meaningful during the global pandemic, but also as an issue for individuals based on their medical history and preferences. We see it as an opportunity to rethink the comprehensive screening obligations that support. Standard business procedure manual. After all, if the benefits of treatment or testing do not justify the risks, Vishal Gawali editorial He and his colleagues at Queen’s University in Kingston, Ontario JAMA Oncology Last month, “It then needs to seriously consider whether it was actually justified, even before the pandemic.”
Not surprisingly, screening tests look for unrecognized diseases or risk factors in asymptomatic people. “A good screening test informs or modifies our behavior in ways that improve someone’s health and quality of life,” says Virginia State University Associate Professor of Family Medicine and Group Health and US Preventive Services. Independent volunteer panel of experts to advise the public on task forces and preventive care. In that measure, blood pressure check is an excellent screening tool. By detecting and processing High blood pressure, This usually does not cause symptoms, you can reduce the risk of heart attack by 20% stroke 30 percent.
At the same time, “tests could be harmful,” Christo added. These harms include unnecessary tests and procedures to track false alarms, unnecessary treatment of benign abnormalities, and anxiety of sudden conversion from healthy people to patients.
For some screens, especially those for specific cancers, the benefits outweigh these risks slightly. For example, 2018 analysis In American Medical Association Journal Data of breast cancer: Screening women with an average risk of 10,000 in their 40s for 10 years could avoid 3 deaths, but 32 died of breast cancer despite screening and 28 were “excessive” Treat cancers that have been diagnosed and are likely to stunt growth. More than 6 in 10 will experience false alarms, requiring more scans or biopsy tracking.
What we are seeing is not the true increase in cancer incidence. This is an overdiagnosis of non-fatal cancers detected primarily by screening.
Screening messages often focus on the idea of ”saving lives” while hiding these annoying uncertainties. Is it really putting your life at risk by delaying or skipping this year’s mammograms? It is unlikely that Welch, the lead author of analysis Of the 40-year cancer statistics published in New England Medical Journal October last year. Welch and colleagues have found that cancer mortality has declined over the last four decades, most of which was not due to screening.
“First and foremost, this is primarily about reducing smoking and the consequent reduction in lung cancer deaths,” Welch said. We can also thank for improved treatment for breast cancer, prostate cancer, and some rare blood-borne cancers. early detection have Play a role in reducing the colon, Cervical cancer Although they died, they were already on the decline before the advent of widespread screening. For reasons that are not fully understood, these diseases, as well as stomach cancer, Frequency of occurrence is low.
But overall, breast cancer, prostate cancer, thyroid cancer, kidney cancer, melanoma Skin cancer. Meanwhile, people die of skin cancers of the thyroid, kidneys, and melanoma at about the same rate as in 1975. “What we’re seeing is not the true increase in cancer incidence,” Welch said. “It’s an overdiagnosis of non-fatal cancers, mostly detected by screening.”
So what does the NCI model tell us about the effect of delayed screening alone on cancer death? For 6 months, 75% of people have breast or Colorectal cancer Screening skipped it. In that simulation, the estimated increase in cancer deaths was two-thirds less than if treatment was delayed. The model can calculate the harm of screening — including overdiagnosis — NCI researchers told me, but they chose not to take it into account.
Data presented to Science The editorial was only a tentative view of the much more thorough work in progress, Sharpless told me. The pandemic provided a once-in-a-lifetime opportunity to investigate what would happen if health care deteriorated and stopped. “This-if so-called natural experiments-provides a true research opportunity to understand this complex topic of screening and overdiagnosis and overtreatment,” he said. “
“This is also an opportunity to look at new technologies for screening, especially those that can be done at home, such as cervical cancer self-sampling,” Sharpless said. Although still under investigation, this test can change lives in low- and middle-income countries where cervical cancer is the leading cause of cancer deaths in women. “Patients don’t want to go back. They really like telemedicine and some of the things we can do,” he said. “If all of this has a silver backing, it means we were forced to be innovative.”
Perhaps, however, marketing suggests that medical centers are eager to return to their pre-pandemic status quo. “This system requires patients,” Welch said. Screening has financial incentives because it involves many people and ensures that follow-up tests and procedures generate income. Of course, he said major medical centers are big companies that want to get patients back. “It’s completely understandable, but we want to ensure that the needs of our system do not exceed the needs of our patients.”
I don’t want the patient to return. I think they really like telemedicine and some of the things we can do.
Christo argues that it’s time to address the often neglected problems associated with mental and behavioral health: “The United States Preventive Services Task Force has recommendations for screening and counseling unhealthy people. Masu Alcohol use, Diet and exercise, weight loss, and depression“If we know that pandemics are exacerbating these problems, preventive services that help people deal with them could have more impact than the tests people focus on. There is to deliver.”
Like everyone I’ve talked to, Sharpless offers more subtle advice than marketing. Most importantly, you need to see someone who has symptoms or is being treated for cancer. “To some people, cancer is a bigger threat [than COVID-19] And that should support their decisions. “But my regular checkup mammogram? “It may be postponed for a while,” he said.
According to family practitioner Krist, the “right” decision depends entirely on the individual patient. For those who are at high risk of illness and whose screening is not up-to-date, it is worth wearing a mask to encourage the clinic. However, he said, even if the immune system is at risk and COVID-19 levels are high, he may want to wait. “These are the types of hard decisions that patients and doctors have to make together.”
However,”Oncology common sense“For Medscape, he argues that these decisions should be based on evidence, not between patient-to-patient fears, both now and after a pandemic.” My biggest disappointment was fearing unhealthy people That’s it.” How feared are they in their minds that they are concerned that they will not be screened during a pandemic? That means the fear is pretty real and it’s so great. “
Teresa Carr is a Texas-based research journalist and Undark’s The matter of fact column. This article was first published Not dark..
