Don’t Delay Cancer Screenings During COVID-19

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, elective medical procedures, including cancer screenings, were paused to reduce the spread of COVID-19 and to avoid overwhelming the healthcare system.

This enabled healthcare providers to prepare to safely see patients who required in-person visits.

“When this all started, we all had to shut down what we normally do in medicine because we didn’t have specific safeguards in place for COVID-19,” says UNC Health gastrointestinal medical oncologist Hanna Sanoff, MD, MPH. “But, at this point, we’ve put in a ton of precautions to keep you safe.”

So, if you are due for a colonoscopy, mammogram or Pap test, don’t put it off—even during the pandemic—as long as you are not feeling sick or experiencing COVID-19 symptoms. These screening tests can detect cancer in its earliest stages, when it’s easier to treat and leads to better outcomes.

Here’s what you need to know.

Colonoscopies Prevent and Detect Colon Cancer

Colon cancer is the second-leading cause of cancer death in the United States when counting cancers that affect both men and women. A colonoscopy is an examination of the inside lining of the colon, which is where colon cancer starts.

The good news is that a colonoscopy not only detects colon cancer, it can prevent it, too. During a colonoscopy, doctors look for precancerous or cancerous colon polyps. If doctors spot these growths, they can quickly and painlessly remove them during the colonoscopy.

“If we see a polyp during a colonoscopy, we can remove it, and then you have a lower chance of developing colon cancer,” Dr. Sanoff says. “Or if we detect colon cancer early, people are usually cured with just surgery and don’t have other subsequent treatments, such as chemotherapy.”

The American Cancer Society says colon cancer screenings should begin at age 45 for people at average risk instead of age 50, as previously recommended.

“There has been an increase in diagnoses of people who are younger than 50, so the American Cancer Society updated the recommendation,” Dr. Sanoff says. “The recommendation has not been adopted in a widespread fashion, but it’s something to start thinking about at age 45. Talk to your doctor about it.”

If you have a family history of colon cancer, colon polyps or high-risk disorders that predispose you to colon cancer, you should be screened at a younger age, Dr. Sanoff says. This includes people with inflammatory bowel disease, including ulcerative colitis and Crohn’s disease.

“Anybody who has a family member who had a colon cancer diagnosed at a young age should start screening about 10 years before their family member was diagnosed,” Dr. Sanoff says. “So if your dad was diagnosed at 50, you need to start at 40.”

Bottom line: Talk to your doctor about your risk. And if you are due for a colonoscopy, get it.

“I don’t think people should be changing their medical care because of COVID-19 with very, very rare exception,” Dr. Sanoff says.

Early Detection of Breast Cancer Begins with an Annual Mammogram

One in eight women will develop breast cancer. It’s diagnosed more than any other type of cancer and is the second-leading cause of cancer-related deaths for women in the United States. A mammogram is the best weapon for catching breast cancer at an earlier stage, when cancer is more treatable.

“The goal of doing a yearly screening mammogram is that we’re hoping to catch things before they become a mass you can feel,” says UNC Health breast surgical oncologist Barbara Dull, MD. “So if a cancer does show up, we’re catching it in the earliest stages, when it requires less aggressive treatment.” Localized breast cancer has a five-year survival rate of 99 percent.

Women at average risk should start talking to their doctors about breast cancer screening, likely with a mammogram, at age 40. Some women choose to wait until 45 or later to get screened, but you should start the conversation at age 40.

For women at higher risk of breast cancer, for example, because of family history, mammograms should begin earlier, probably in the 30s. Talk to your doctor about when you should begin your screening mammogram.

Bottom line: Schedule your annual mammogram. If you don’t yet get a mammogram, talk to your doctor about your risk and when you should start.

“As long as (COVID-19) precautions are taken in terms of screening patients prior to their appointment and making sure that appropriate PPE is worn by the patient and the healthcare providers, it is perfectly reasonable to resume doing your screening mammograms,” Dr. Dull says.

Pap Tests Can Detect Precancerous Cells in the Cervix

Cervical cancer was once one of the most common causes of cancer death for women in the United States. The cervical cancer death rate dropped significantly with the increased use of the Pap test, which can detect changes in the cells of the cervix before cancer develops or when it’s small and easier to cure.

“There are very few places in the body where you can actually identify a precancer and have an intervention, and the cervix is one of them,” says UNC Health gynecologic oncologist Wendy Brewster, MD, PhD. “In the United States, cervical cancer is one of the most preventable cancers.”

If the precancerous lesions are treated, then cervical cancer may be prevented. There are two screening tests for cervical cancer: the Pap test and the HPV test.

“You can test for cervical cancer with a Pap test or an HPV test or both,” Dr. Brewster says. “When both tests are used, this is called co-testing.”

The American Society for Colposcopy and Cervical Pathology recommends that women have a Pap test every three years beginning at age 21. After age 30, HPV testing is preferred. The frequency of cervical cancer screening depends on your calculated risk of having cervical precancer or cancer and is based on your medical history.

Researchers have found that the HPV test may detect abnormal cervical lesions earlier and more accurately than the Pap test alone. For women ages 30 and older, the Pap test alone is acceptable only if HPV testing is not available. In those circumstances, it should be performed annually.

Bottom line: Talk to your doctor about whether you are due for a Pap or an HPV test.

Even during COVID-19, “women who have recently had an abnormal Pap test that required additional follow-up should adhere to their provider’s recommendations, especially if the physician had a serious concern,” Dr. Brewster says. “We have a window in which we can do something, such as remove the precancer lesion to prevent it from developing into a cancer.”

Minimize Your Risk Inside and Outside the Clinic

There are steps you can take to make it less likely that you’ll catch the coronavirus while getting your cancer screening, including:

  • Engaging in frequent hand-washing before and after your appointment
  • Wearing a mask any time you will be indoors or around others
  • Staying at least 6 feet apart from others

“In doctors’ offices, everyone should be in masks and should follow the established guidelines, not only on the clinical side but also on the patients’ side,” Dr. Brewster says. “I would venture to say that doctors’ offices are the places where there’s probably the highest (safety) compliance.”

Call Your Doctor if You Have Any Cancer Symptoms

If you have a concern such as blood in your stool, abnormal vaginal bleeding or a lump in your breast, call your doctor immediately. Don’t delay treatment without first consulting your doctor.

“We feel very strongly that we don’t want people dying of cancer who wouldn’t have died of cancer if the pandemic hadn’t happened,” Dr. Sanoff says.

If you’re concerned about your cancer risk, talk to your doctor. For the latest information on COVID-19, visit the CDC website and the UNC Health COVID-19 Resources page, and follow UNC Health on Twitter, Facebook, Instagram and YouTube.