People who have been diagnosed with one type of cancer are at a higher risk of having a second cancer later on. This medical reality, coupled with the fact that cancer screening rates have plummeted significantly during the COVID-19 pandemic, highlights how important it is that cancer survivors have regular screenings for other types of cancers, according to Edith Mitchell, MD, Clinical Director, Center to Eliminate Cancer Disparities, Sidney Kimmel Cancer Center in Philadelphia, PA.
Dr. Mitchell discussed this topic at the 2022 Summit on Cancer Health Disparities.
“Women and men who have had breast cancer need screenings for other cancers as well,” said Dr. Mitchell. “Therefore, we need to close the gap in cancer screenings.”
Closing the Gap
By this “gap” she means the disconnect between recommendations for cancer screening and actual screenings that people are undergoing. For example, it is recommended that patients who have had breast cancer should have screening for lung cancer, but few patients actually get such screenings. To close this gap, it is crucial that more patients should undergo lung cancer screening.
At the beginning of the pandemic, the United States had a 90% reduction in breast cancer screenings alone, which is a remarkable reduction in screening.
The National Cancer Institute has predicted that the impact of these missed or delayed cancer screenings will result in an increase in cancer diagnoses in the future, and that those who will be diagnosed with cancer will likely have a more advanced stage of the disease, which is more difficult to treat, and will therefore result in an increase in the number of deaths from cancer in the United States.
However, Dr. Mitchell said, it is not too late to intervene and change this situation, asking doctors to encourage people to continue cancer screening.
The decrease in cancer screenings caused by the COVID-19 pandemic led the President’s Cancer Panel to publish a report of recommendations that are focused on “closing gaps in cancer screening.” This report goes hand-in-hand with President Biden’s recommitment to the Cancer Moonshot program, whose goal is “ending cancer as we know it” by cutting by half the number of cancer deaths in the United States in the next 25 years.
But because many women do keep up with regular breast cancer screenings, Dr. Mitchell hopes that mammograms can lead to other cancer screenings as well.
Screening Saves Lives
Newly updated guidelines now recommend earlier screenings for colorectal cancer and for those at risk for lung cancer.
An important screening for men is PSA, or prostate-specific antigen test. This test can detect prostate cancer early on, when successful treatment is quite common. By contrast, avoiding PSA screening often results in late diagnosis of prostate cancer, when the cancer is at an advanced stage or has spread in the body (metastasized) and cannot be cured.
Dr. Mitchell told the story of a woman who did not have breast cancer, but who owes her life to her breast cancer screening. This woman had a mammogram that came back negative (meaning no cancer), but her doctors recommended that she have additional testing for other types of cancers.
These screenings revealed that she did have 2 other common cancers—colon cancer and lung cancer. Because these cancers were detected early thanks to those screenings, her treatment was successful.
“Five years later, post-treatment, she is alive and doing well,” Dr. Mitchell said. “And this is because of breast cancer screening as the initial effort.”
Dr. Mitchell said that cancer screening during the COVID-19 era has been incomplete and uneven. Patients are not being screened as often as they should be, and they are not following up with their doctors in time, or not at all, after they get abnormal test results.
These issues are even worse among black or Hispanic people, and in people who are socially or economically disadvantaged. The rates of cancer screenings are also much lower among people living in rural areas, and those living in areas with lower levels of education.
Barriers to Cancer Screening
These barriers often exist because of a lack of education or understanding about the importance of cancer screenings in the general population. Many people are unaware of the need to follow cancer screening guidelines or to ask their doctor about screening for different types of cancer.
For example, the guidelines for colorectal cancer now suggest that people start screening at age 45 instead of 50 as was recommended before.
This situation is made even worse because many cancer providers do not inform their patients on the cancer screening recommendations, Dr. Mitchell added. Knowing where to get a cancer screening, and having easy access to get to that place, are also common barriers.
Other barriers include fear, stigma, men’s reluctance to consider health issues, and cost, or lack of insurance coverage. Annual mammograms for women after age 40, for example, are fully paid by all types of medical insurance, but some women may not even be aware of that.
Dr. Mitchell said that the only way to reduce the rates of cancer deaths in the United States is by breaking down these barriers through education, and by improving access to cancer screenings. Finding breast, prostate, lung, or colon cancers earlier through improved access to screenings—and thereby treating them earlier—is the only sure way to “close the gap” and improve cancer outcomes and survival, she said.
She emphasized that patients can and should be proactive about their own cancer screenings. The FDA has already approved at-home stool-based test kits (such as Cologuard) for colorectal cancer screening, and new research is focused on developing HPV self-tests for cervical cancer (although these are still not FDA-approved).
Perhaps most important, she said, patients can take the initiative to ask their cancer providers, navigators, or even their primary care doctors about screening for other types of cancers.
Oncologists and other healthcare providers are often being pulled in many different directions, making it difficult for them to fully address all of a patient’s needs during a short visit, especially during the COVID-19 era, when face-to-face visits may still be limited in some places.
In addition to asking about screening for other cancers, patients should feel empowered to ask their doctors about genetic testing that screens for the risk of certain cancers. For example, women who are at high risk of breast cancer, or those who have already been diagnosed with breast cancer, should be screened for the BRCA gene mutation.
“Screening for BRCA gene mutations has not been utilized in this country at all to the extent possible,” she said. “Many individuals are not even offered genetic testing after a breast cancer diagnosis, and this is especially true for racial and ethnic minorities.”
Similarly, all patients with lung cancer should ask for genetic testing, because different treatments are available today for lung cancer with different types of genetic mutations (changes).
Dr. Mitchell encourages all members of the healthcare team to promote and encourage cancer screenings. She also encourages patients to see themselves as crucial members of that team and take an active part in their treatment plan, which should include screening.
- People diagnosed with one type of cancer are at increased risk of having a second cancer
- Cancer screenings have been down because of the COVID-19 pandemic
- The United States had a 90% reduction in breast cancer screenings alone at the beginning of the pandemic
- Missing cancer screenings will result in an increase in cancer diagnoses in the future, and at a more advanced stage
- Barriers to cancer screenings include fear, stigma, men’s reluctance to consider health issues, cost, or lack of insurance coverage
- Patients should ask their cancer providers, navigators, or primary care doctors about screening for different cancers
American Cancer Institute
Breast cancer screening
American Lung Association
Lung cancer screening
CDC: Centers for Disease Control and Prevention
Colorectal cancer screening
National Cancer Institute
Prostate cancer screening