COVID-19 and CRC Screening
Colorectal Cancer Screenings Saves Lives
From 2000-2018, there has been a strong increase in colorectal cancer screening, which has a clear impact on incidence, staging, and survival. As shown in Figure [1] and Figure [2], both the trends and the data over the last decades have clearly and overwhelmingly established the benefits of regular and timely screening for colorectal cancer.
Incidence & Rate of Diagnosis
This year, it is predicted that an estimated 147,950 adults in the United States will or have been diagnosed with colorectal cancer. These numbers include 104,610 new cases of colon cancer (52,340 men and 52,270 women) and 43,340 new cases of rectal cancer (25,960 men and 17,380 women). Part of the process of diagnosing CRC is the screening process, namely, colonoscopies.
But what if screening rates were disrupted and the positive screening trend suddenly reduced? Long term data suggests that that there is evidence that potential delays could lead to more advanced staging and risk of mortality. [3] and [4]
Delay in the presentation of symptoms and in referral of patients for surgical opinion remains an important problem in colorectal cancer. Factors influencing patients to consult early include advice from close family or other associates and abdominal pain or vomiting, or both, as one of the early symptoms. More localized rectal symptoms and loss of weight are often associated with long delay. The "classic" symptom pictures are not often seen in the early stages of the disease. Few identifiable factors were associated with delay in referral for surgical opinion… … There is some evidence that delay is associated with stage of the disease at presentation.
Macarthur, Christine & Smith, A. (1984)
The COVID-19 Paradigm
Our world under a pandemic has been and continues to be a very unique experience, with many at home in isolation, and everyone facing some form of hardship or another.
On March 13, 2020, a United States national emergency was declared due to COVID-19. Subsequently, the American Cancer Society recommended that no one should go to a healthcare facility for routine cancer screening until further notification. Other societies such as The American Society of Breast Surgeons, the American College of Radiology, and the American Society for Colposcopy and Cervical Pathology also advised patients to postpone elective care – including cancer screening – and plan to reschedule screening tests when healthcare facilities resume screening. The COVID-19 pandemic has led to unprecedented drops in breast, colorectal, and cervical cancer screenings.
COVID-19 & Colorectal Cancer Screening Webinar - American Cancer Society and the North Dakota Colorectal Cancer Roundtable
And with the cancellation of “non-essential” medical appointments or procedures, including colonoscopies, there has been a drastic reduction in the number of screening procedures that are involved in the identification and diagnosis of CRC and other cancers. In fact, a report by the IQVIA Institute [5] has reported that the COVID pandemic has led to an extreme reduction of nearly 90% in CRC screening in April, as compared to February of 2020, and prior year monthly averages. The resulting backlog of cancer screenings will pose significant challenges for health systems as they adopt new processes and protocols necessary to safely restart screening.
Source: IQVIA Real World Claims, April 2020
What’s the impact of delayed screening and diagnosis?
The research from IQVIA suggests that the delays in screening in April resulted in a reduction in the rate of CRC diagnosis by 32%, and while that might at first sound like a good thing - what it really means is despite less diagnosis, there is no actual change in incidence. This could predict delay in diagnosis for over 18,000 patients in April alone. That is 18,000 people who don’t yet know they have cancer and will face a prognosis that is made much more challenging the longer they go without a diagnosis.
What are local providers doing to protect patients while continuing to push screening?
As rates of infection and life-threatening illness have either been averted or significantly diminished, various areas around the country are now easing restrictions on elective medical care. Recommendations related to re-opening should be flexible, especially if there as a resurgence of COVID-19 cases in any community – in which case elective cancer screenings may be restricted again.
COVID-19 & Colorectal Cancer Screening Webinar - American Cancer Society and the North Dakota Colorectal Cancer Roundtable
If you have symptoms of CRC, regardless of age, it is important to understand that delaying diagnostic procedures is not an option - please take steps to talk to your doctor about a colonoscopy. As a reminder, here are some of the most common symptoms of colorectal cancer [6]:
|
Know the Common Symptoms |
|
|
Constipation |
50% |
|
*Blood in Stool |
50% |
|
Bloating |
43% |
|
*Rectal Bleeding |
39% |
|
Diarrhea |
37% |
|
*Narrow Stool |
37% |
|
Gas |
36% |
|
Pain |
36% |
|
Persistent Cramps |
36% |
|
Weakness and Fatigue |
31% |
|
*Extreme Weight Loss |
16% |
|
Nausea or Vomiting |
14% |
|
*Symptoms that warrant elevated urgency in seeing your health care provider – any major change in bowel habits warrants review with your doctor. |
|
If you have a family history of colorectal cancer and are due for screening, we again would urge you to work with your local medical providers to take the right precautions, moving forward with your necessary screening or diagnostic procedures like colonoscopies, while reducing your exposure to more elective appointments or procedures. If you are over 45-50, you can also consider speaking to your doctor about screening options like Cologuard® which enables patients to complete the tests from their home.
Medical providers are equipped with specific methods to help protect patients and themselves from the spread of COVID-19. Here are some examples of methods that may be used by hospitals or cancer centers:
Patients are asked to wear mask when they show up for appointment
Patients, visitors and staff will have their temperature checked daily
Visitors or caregivers are limited or not allowed during times of peak viral spread
Limiting total number of patients in lobbies and waiting areas
Chairs in the waiting area are placed six feet apart
Staff will be wearing masks and PPE during appointments and procedures
In Closing
Fear of COVID-19 is understandable, and we do strongly support guidelines that keep social distancing and reduced opportunity for exposure. But it is also important that we do not ignore the danger of delayed screening, diagnosis, and treatment for those that require it. Please consider speaking with your doctor about your next colonoscopy and doing so safely under this pandemic paradigm.
REFERENCES:
BRFSS Percentage of U.S. Adults Age 50-75 years Up-to-Date with CRC Screening. https://nccrt.org/data-progress/
Evidence of Increasing Mortality With Longer Diagnostic Intervals for Five Common Cancers: A Cohort Study in Primary Care. Eur J Cancer. 2013 Jun;49(9):2187-98.
doi: 10.1016/j.ejca.2013.01.025. Epub 2013 Feb 27.
Shifts in Healthcare Demand Delivery and Care During the COVID-19 era
“Never Too Young" 2018 Young-Onset Colorectal Cancer Survey Report. Colorectal Cancer Alliance (2018)
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