The pandemic has delayed cancer diagnoses

Laurie Allen
Dr. David Cohn, chief medical officer at Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Solove Research Institute

A precipitous drop in mammograms, colonoscopies and other preventive screenings is among the many repercussions of the Covid-19 pandemic, but local imaging experts say the tide is turning. The benefit of having test procedures, they agree, far outweighs the risk.

“It’s incumbent on us to let people know it is safe to be back in our system,” says Dr. David Cohn, chief medical officer at Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Solove Research Institute. “It’s critical that business leaders know that we understand what needs to be done for the safety of our patients, and we encourage them to have their employees get in for testing.”

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When the pandemic headed toward Central Ohio early this year, The James and other hospitals quickly reallocated resources to prepare for incoming patients. Health care systems postponed elective surgeries and outpatient procedures, including non-emergency imaging tests. “We did such a good job that even after we were back to levels where we could accommodate patients, patients didn’t come in,” Cohn says.

Imaging providers throughout the Columbus area curtailed a significant portion of their services and saw the resulting drop in volume and revenue. Radiology Inc., which provides imaging services for Mount Carmel Health System, saw a 57 percent decline in April, which translated to a 50 percent revenue loss, says President Dr. Gerald Smidebush. “That was a big hit,” he acknowledges.

Jason Guagenti, vice president and executive director of Riverside Radiology and Interventional Associates, the contracted radiologists for OhioHealth, says practice volumes were 40 percent of what they were pre-Covid.

Financial implications are but one part of the picture, experts say. Postponed tests pose a concern about time lost in diagnosing serious illness.

At Ohio State University Wexner Medical Center, lung cancer diagnoses fell 50 percent during the first half of 2020, which likely is due to fewer screenings, says Dr. Mark King, interim chairman of the department of radiology.

The declines mirror national and global trends suggesting that cancers went undiagnosed during the pandemic’s peak. A report in the Journal of the American Medical Association said weekly diagnoses of breast, colorectal, lung, pancreatic, esophageal and gastric cancers were 46 percent lower in March and April than they were in the period from January 2019 to February 2020.

Figures from the United Kingdom were more stark, with the UK reporting a 75 percent drop in weekly referrals for suspected cancer.

In an editorial published in Science, National Cancer Institute Director Dr. Norman Sharpless warned that an additional 10,000 people in the U.S. will die of breast and colorectal cancers in the next decade as a result of delays in screening and diagnosis during Covid.

Locally, radiology experts are encouraged by the rebound in testing that’s occurred over the past few months, but there is lingering concern about the long-term ramifications of missed testing earlier this year. Despite vigorous efforts to re-engage and reschedule patients, the reality is that some may not return in a timely fashion, or at all.

Cohn and others say a delay of three to six months isn’t likely to change the course of someone’s illness, but waiting a year or until symptoms appear is worrisome. “Our biggest fear is that people who delay are pushing out their diagnosis date, when the cancer is harder to treat,” Cohn says.

Riverside Radiology’s Guagenti adds, “We feel that people are in more danger of not having the imaging test. The risk is very low, and the benefit is tremendous.”

Standard practice at most imaging sites includes pre-procedure screenings, temperature checks and masks. Waiting areas have been reconfigured or eliminated to make sure patients remain at safe distances, and changes in scheduling have reduced the number of patients in an imaging facility at any given time. Additionally, providers have made increasing use of telemedicine for video visits and remote radiology interpretation. Radiology practices, health care systems and in some cases, individual physicians have invested capital to expand infrastructure and enable more services to be delivered off-site.

Certain procedures, such as colonoscopies, now require a Covid test prior to the visit. Time between procedures also is longer to allow for thorough cleaning of equipment.

The Covid test itself may cause people to avoid imaging exams such as colonoscopies. King’s two daughters had to have the tests for their jobs, and he tells others what they told them: “It’s a very small episode of pain to get really important answers.”

Mobile mammography units, which also were sidelined, are getting back into service. The James unit allows only two patients on the coach at a time and encourages them not to arrive early for their appointments. Staff are screened every day and wear masks and protective eyewear.

Mount Carmel’s mobile unit will resume in October after being a Covid testing site. “I’m really encouraged about how things are coming back,” Smidebush says. “There is hope.”

In King’s view, Covid has changed the medical profession. Ordered tests will receive far closer scrutiny than in the past as providers work to minimize exposure while maximizing clinical benefit, he believes.

The Covid-related death of OSUMC’s director of imaging services (which manages radiology technologists) galvanized efforts to combat the coronavirus earlier this year, King says. Jeannie Danker died in late March from what her family said were complications from Covid. “If the director of imaging could lose her life, it underscored how serious this is.”

With the new procedures and protocols now in place, he says coming back to the healthcare environment is safe. “I feel safer going to a hospital than a restaurant. You will not see people violating mask or distancing requirements.”

Laurie Allen is a freelance writer.