COVID-19 is the most talked about health concern in 2020, but for many, it is not the deadliest disease. University of Colorado Cancer Center leadership is bringing attention to the fact that people may die from preventable cancers because of the pandemic’s interruption to the health care system.
“Cancer is still the number one cause of death in Colorado,” says Cathy Bradley, PhD, deputy director of the CU Cancer Center and Colorado School of Public Health’s associate dean for research. “COVID might be a bigger concern for those over the age of 80, given that they have a shorter lifespan. But for younger age groups, cancer is still an important concern and can be deadlier than COVID.”
According to the American Cancer Society, there will be an estimated 606,520 deaths due to cancer in the United States this year. As of today, the John Hopkins tracking website share that 154,944 people have died of COVID-19 in the United States. If you look at those numbers in Colorado you have an estimated 8,220 deaths due to cancer and so far, 1,844 deaths from COVID-19.
“Both are terrible devastating diseases that cause a lot of death, they impact the ability to make a living and they cause a lot of pain and suffering,” says Richard Schulick, MD, MBA, director of the CU Cancer Center, and professor and chair of the CU Department of Surgery. “I look forward to the time that there will be a vaccine for COVID and COVID will be taken off the table. But I think we have a lot more work to do with cancer. I am hopeful that one day in the not too distant future we will actually be able to conquer a lot of the cancers that Americans and Coloradoans suffer from.”
There are two large concerns for oncologists and cancer researchers when looking at the long-term impacts COVID-19 has on cancer; those are, the reduction of preventative cancer screenings and treatment changes.
Reduction in cancer screenings
“It is important to continue to do what you can to stay healthy. Part of being healthy is getting cancer screenings,” says Bradley. “Like wearing masks and social distancing to protect ourselves from COVID, we also need to continue to protect ourselves from cancer through regular screening and reducing risks through a healthy lifestyle.”
Norman “Ned” Sharpless, director of the National Cancer Institute had an editorial published in the journal Science that estimated the COVID-19 pandemic will likely cause at least 10,000 excess deaths from breast cancer and colorectal cancer over the next 10 years in the United States. These numbers are due to people not getting mammographies and colonoscopies since the start of the pandemic. This is a 1% increase in deaths but Sharpless noted that these are conservative numbers because they do not include treatment delays and treatment interruptions caused by the pandemic. Nor do they include preventive behaviors like getting HPV vaccines.
Other areas to consider include other cancer types that are not breast or colorectal, the impact of upstaging (being diagnosed at a later stage) and how long the coronavirus disruptions will last. Many health officials are predicting a “second wave” which would increase the number of deaths projected.
According to EPIC, a popular electronic health record system, there has been a drop between 86% and 94% in preventive cancer screenings for cervical, colon and breast cancer performed across the United States, presumably due to access disruptions caused by COVID-19. These numbers look at averages each week in 2020 and compared them to equivalent weeks from 2017–2019. We have seen a similar decrease in the numbers of screening with our doctors.
“Routine screening for cancer is extremely important. We would prefer to prevent it than to treat it, just like now with COVID we want a vaccine, so we never get it. The same is true when you think about screening for cancer or getting an HPV vaccine” says Bradley. “In the case of colorectal cancer, with screening we can remove premalignant tumors so that it never progresses and with an HPV vaccine, we prevent the cancer from occurring altogether.”
If the trend of reduced cancer screenings and absence of vaccines continues, the data suggest that many cancer cases could go undiagnosed or be diagnosed at a later stage with a poorer prognosis.
While there is no data out yet on the impact delaying or reducing treatment, we do know it will have an impact.
“We were very fortunate in Colorado that our cancer center was able to continue infusions,” says Bradley. “Very few cancer centers across the country were able to keep up infusions, with many only now starting to ramp up again.”
This was due to many cities and states considering cancer treatment as elective. In Colorado, Governor Polis left all cancer treatments as necessary procedures.
“You would not want to be the person in the middle of your treatment or starting treatment and having to have it delayed by several weeks or months,” says Bradley.
Fortunately, at the CU Cancer Center infusions stayed at about 98% of pre-COVID levels while cancer-related surgeries dropped to about 60% of pre-COVID levels. Now, the surgeries are at about 110% of pre-COVID levels to make up for all the patients that did not come in or delayed their care.
But delaying treatment was not the only change, many places changed the standards of care.
“One of the interesting things that is going on around the country is that some of the doses of chemotherapy and other infusion therapies have been reduced to decrease the chances of side effects so that a patient would not be as susceptible to an infection or getting sick,” says Bradley. “We do not know what that does to treatment effectiveness. So now there are some discussions around if we needed to give that much chemotherapy or treatment to begin with or if instead, we are giving treatment at inefficacious doses. We don’t know.”
Safe to get screening or treatment
“The in-hospital infection rate is extremely low. At this point clinics have become savvier at reducing the risk of infections. If patients are doing their part with wearing masks, washing their hands and social distancing the actual clinic environment is relatively safe,” says Bradley.
For those who have already missed their screening, Bradley recommends that people work with their doctor to weigh their own risks, especially looking at items like family history, and strongly consider getting the screenings they need.
“Most providers would tell you that their clinic environments are safe and that the risk of cancer is greater.”
Impacts on underrepresented groups
Community-based research, studies that are aimed at underrepresented groups like rural and Hispanic populations, had been put on hold longer than any other research area because it is in the least controlled environment.
“Health disparities are only going to be exacerbated during this pandemic and the risk of cancer continues to rise,” says Bradley. “It is unfortunate that these types of research are set back because it is all about prevention, treatment and getting people the care that they need. This will have an immediate negative impact on these communities.”
Bradley along with other members of the CU Cancer Center have applied for a supplement to look at the excess in incidents and upstaging that occurs in rural Colorado. The team recently learned that the National Cancer Institute will fund this research.
On the positive side
The COVID-19 pandemic is not all bad news.
“In times of crises, we do tend to see incredible medical advancements,” says Bradley. “A lot of cancer treatments have been repurposed to see their effectiveness with the treatment of COVID. This may lead to us getting better in some areas of cancer treatment and have a chance for new discoveries. Discoveries in treating and preventing COVID may apply to cancer. Advancements in telehealth will unquestionably benefit cancer patients. Challenges often accelerate and bring about our most creative thinking and willingness to work together.”