The Tragedy of Delay

Yet another fatal impact of the SARS-CoV-2 virus has been due to cancers going undetected as people dropped their annual health maintenance screenings.

Waiting until symptoms manifest has deadly consequences. Despite that, when daily life poses existential threats from a virus that has taken millions of lives, thinking about a trip to a hospital or doctor’s office when you’re feeling OK just isn’t the priority it was when life was ‘normal.’ A study of cancer screening tests at Massachusetts General Brigham showed a 74% drop-off of screenings (year over year) for the 3-month period of Covid lockdowns (March-May 2020). In the three subsequent months, screenings didn’t surge from pent-up demand. Instead, they remained about 20% lower than pre-Covid. Over the combined 6 months, screenings were down more than 40%.

This is only short-term data, and yet we should be concerned about health outcomes in our age of Covid, not just from the virus but from the loss of health benefits from routine screenings. The Massachusetts General Brigham study was based on patients who obtained one of five cancer screening tests: mammography, colonoscopy, Pap test, PSA test or low-dose CT scan. Depending on the sex and age of the patient, more than one test might be required to screen for multiple cancers.

+To someone hesitant to enter a healthcare setting for maintenance screening, how likely is that person to repeat this process multiple times?Some healthcare systems have started thinking about providing services to patients in their homes, given the overall hesitancy to go to the doctor when feeling well. The National Cancer Institute reports:

“We’ve learned some things during the pandemic that could lead to better screening practices in the future,” said Jennifer Haas, M.D., of Massachusetts General Hospital, who studies cancer screening. “For instance, the pandemic has created an opportunity to promote home-based screening tests, such as the fecal immunochemical test (FIT) for colorectal cancer.”

FIT does not require an initial in-person medical appointment.

A person collects a stool sample at home using a kit they receive in the mail and sends it to a laboratory for testing.

A recent report showed that a large health care system in California continued to send FIT kits to its eligible members in April and May of 2020—after the use of most cancer screening tests had dropped. But despite the pandemic, the FIT response rates for members remained high.

“FIT could be a model for developing other cancer screening tests,” Dr. Haas said. Home-based screening tests are being studied for cervical cancer, though none has yet been approved by the US Food and Drug Administration, she noted.The pandemic may lead to other potential innovations in cancer screening.

-National Cancer Institute

I share that optimism that innovation is not only needed, but it’s also critical to early detection and saving lives. The FIT screening kit works for one type of cancer, but is it even possible to deliver image-based screening to a person’s home? Obtaining the material for a FIT test is easy enough to do at home; the same isn’t true for obtaining the cells required for a PAP smear.

Driven to smell

We have working models of an alternative in practice today. The Cancer Dogs ( organization is working to screen fire fighters (whose jobs expose them repeatedly to carcinogenic materials) for cancers.

The screening process is simple: breathe into lab-provided face masks for 30 minutes (three masks per sample) and return the masks for screening. Dogs sniff the samples and flag those that match the cancer odor that they’ve been trained to detect. Those with positive samples proceed with traditional medical screening and health care.

Cancer Dogs are able to detect early cancers and save lives. Visit their website to learn more about the good work they’re doing. The SARS-CoV-2 virus continues to evolve into new strains and we’re seeing nothing to indicate a foreseeable return to life as it was before Covid-19. This is tragic enough. Providing alternatives to bring health screening into homes could prevent even more unnecessary loss of life.

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