Cancer Screening During The COVID-19 Pandemic

The past year has been dominated by the COVID-19 pandemic. Although we’ve had a lot to worry about, and many of us have put our lives on hold this past year because of it, I wanted to discuss the importance of cancer screening. Cancer screening is done to identify disease at an early stage in patients who do not have symptoms. The basic premise is that early detection of cancer can lead to an eventual cure and improved outcomes. There is data emerging about the effects of delaying routine medical care because of the COVID-19 pandemic. The worry is that delays in cancer screening specifically, will mean a diagnosis of cancers at later stages.    

Cancer is a broad term for a group of diseases caused by the transformation of normal cells into abnormal cells. These abnormal cells grow uncontrollably and have the potential to spread throughout the body. This can be caused by both environmental and hereditary (genetic) factors. Environmental factors can be preventable and include tobacco, excess alcohol, dietary factors, obesity, and a sedentary lifestyle. The single most preventable cause of cancer is tobacco.

Cancer is the second leading cause of death in the United States, with heart disease the first. Cancer can develop at any age, however, most often occurs in middle age. The risk of cancer also increases as we age. The lifetime risk for developing cancer is nearly one-half in men and one-third in women. The top 4 causes of cancer death in the U.S. are lung, colon, breast, and prostate. 

As a gastroenterologist, I am going to focus on the importance of colon cancer screening; however, age-appropriate screening for common cancers is a discussion to have with your primary care physician. Colon cancer is the 2^nd most common cancer in the U.S. Risk factors include age (about 90% diagnosed in patients over age 50), tobacco, family history, obesity, heavy alcohol, colon polyps, and a diet high in red meat. Certain colon polyps are precursors to colon cancer and are considered precancerous. Signs of colon cancer can include blood in the stool, change in stool caliber or bowel habits, and abdominal pain. Over the last 2 decades, as a result of improvements in early detection and treatment, colon cancer cases and deaths have been decreasing. However, when we look at the numbers closer, the improvements have occurred in the 50 and older age group. A particular concern has been an increase in cases of colon cancer in a younger population. In 2020, it is estimated that about 12% of colon cancer cases will be in patients less than 50 – about 18,000 cases. The reason for this is not known, but likely related to lifestyle and dietary factors. 

Currently, only about 70% of the population aged 50 to 75 are up to date on colon cancer screening. The age at which screening for colon cancer begins depends on one’s risk. In patients at higher risk which are those with a family history of colon cancer or polyps, generally, screening starts at age 40 or earlier. Average risk patients are those without a family history. The starting age is 45 for average risk African Americans and 50 for others. However, recent recommendations from the American Cancer Society and the United States Preventative Services Task Force (USPSTF) are to consider starting screening at age 45 because of increasing incidences of colon cancer in a younger population. Screening is to be individualized in those between age 75 and 85 years old based on functional status and life expectancy.   

There are several screening options to consider. The only screening test in those with a family history of colon cancer or polyps is a colonoscopy. Screening options in average-risk patients include a colonoscopy every 10 years, stool fecal immunochemical test (FIT) every 1 to 3 years based on which type of test is taken, sigmoidoscopy every 5 years, or CT colonography every 5 years. An important distinction to remember is that colonoscopy is the only test that can both detect, and prevent colon cancer by removing colon polyps during the procedure. Additionally, if any of the other screening modalities are positive, a colonoscopy must be performed. You should talk to your gastroenterologist or healthcare provider about the differences in screening options. A screening test for colon cancer is generally mandated to be covered by your insurance company. In-depth information regarding colon cancer screening is also available at www.arizonadigestivehealth.com. 

For the most part, I believe many diseases can be prevented with a well-balanced diet, exercise, avoiding tobacco and excess alcohol, and maintaining normal body weight. Unfortunately, even by doing everything right, we can develop cancer. Earlier detection of cancer leads to earlier treatment and the potential for a cure. We should also be serious about any symptoms we encounter. Any symptoms of blood in the stool, change in bowel movements, and abdominal pain; however minor one may consider them, should be investigated further. The past year has felt like a marathon, and we are getting closer to the finish line, but I fear that missed opportunities with cancer screening will lead to further suffering. I would encourage every reader to discuss cancer screening with their healthcare professional or specialist.