Just like cardiologists and neurologists are worried about people putting off care for heart attacks and strokes during the coronavirus pandemic, oncologists are worried that people are skipping routine cancer screenings as well as putting off seeing a doctor if they are experiencing symptoms.
In March and April, locally, clinics saw an 80% reduction in mammograms and a 90% reduction in colonoscopies, says Dr. Miguel Albino, a hematologist and medical oncologist at Texas Oncology. Now, he says, it’s still about one-third fewer screenings than clinics would be seeing typically.
"Cancer doesn’t stop for COVID," he says. "If we ignore these cancer screenings and we postpone them, it’s going to lead to more people diagnosed at stage four. We’re starting to see it already."
Those stages matter. "If you wait, a potential cancer can go from stage two to three in a matter of months, or stage one to four in even less time if it’s an aggressive form," Albino says.
For breast cancer, a stage one cancer has a cure rate as high as 98%, Albino says, but if it goes to stage four, "you went from a sure thing that you will be cancer-free after some treatments to cancer treatments for the rest of your life ... from one that is curable to one that is incurable and having your life cut short, in a matter of months," he says.
Sometimes the symptoms of cancer can be subtle or confusing or overlap with the symptoms of other diseases, but you should see a doctor if you are experiencing any of these:
• Feeling any lump
• Persistent changes in bowel habits
• Persistent bloating or abdominal or pelvic pain
• Feeling full quickly or having trouble eating
• The urge to urinate more often or difficulty urinating
• Blood in the stool or urine
• Bleeding after menopause, between menstrual cycles or after sex
• Feeling like something is different in the way your body feels
• Unexplained weight loss or gain
• Severe pain with an acute onset
• A cough that doesn’t go away
"Catching these cancers early, recognizing these symptoms, is extremely important to be able to treat them effectively and for survival," says Dr. Yvette Williams-Brown, a gynecologic oncologist at UT Health Austin’s Livestrong Cancer Institutes.
For ovarian cancer, it has a 90% survival rate if you catch it in the early stages, but Williams-Brown says most are caught in the later stages, stage three or four.
"It’s extremely important to listen to symptoms and not ignore it," she says. Often with gynecological cancers, they will be mistaken for something else, she says, and women will get passed from specialist to specialist.
Williams-Brown reminds people to "advocate for themselves" if symptoms continue.
Here are the regular screenings you should do at home:
• Skin checks for any mole or freckle that has changed
• Monthly breast exams or testicle checks
Here are the screenings a doctor will do or order:
• Skin checks annually beginning in your 20s
• Blood panels annually
• Pap test to screen for cervical cancer every three years beginning at age 21 for women. Beginning at age 30 until age 65, a Pap test and a DNA HPV test every five years or a Pap test only every three years. Or a high-risk human papillomavirus (hrHPV) test only every five years starting at age 21. After 65, doctors weigh your risk factors to determine if continued testing is needed.
• Mammogram annually beginning at age 50 to age 70, unless a woman has a first-degree relative with cancer; then 10 years before the age that relative was diagnosed. For some cases, an annual MRI beginning at age 40.
• Clinical breast exam every three years in your 20s and 30s, annually beginning at 40
• Men with a higher risk of prostate cancer should begin screenings at age 40 or 45. Prostate screenings annually for all men age 50-80. Prostate screenings can include a blood test and a digital rectal exam.
• Colorectal screening beginning at age 45 (or earlier with an increased risk) using either a guaiac-fecal occult blood test, a fecal immunochemical test or a stool DNA every three years; or a flexible sigmoidoscopy, a double-contrast barium enema or virtual colonoscopy every five years; or a colonoscopy every 10 years, until age 80
• People ages 55-74 who have a history of smoking should have a yearly CT screen for lung cancer.
All screening sites should be taking COVID-19 precautions including asking screening questions, taking temperatures, having everyone including staff and patients wearing masks, distancing in the waiting rooms or having you wait in the car.
You can ask your doctor for recommendations of places that are taking the right measures, and you can call ahead to see what that location is doing.
"If you feel uncomfortable, go ahead and cancel that appointment, but don’t leave it at that," Albino says. "Tell your doctor what happened."
That will enable the doctor to know not to refer future patients there. Ask the doctor for another option for your screening.