During the depths of the COVID-19 pandemic, the most vocal proponents of aggressive lockdowns often framed the issue as a trade-off between personal freedom on the one hand and public health on the other.
Stay-at-home orders may have prevented some people at the margin from congregating and spreading the virus. But they also convinced lots of people to forgo routine medical care, including screening for diseases like cancer. That care forgone may have dire public health consequences of its own.
Two-thirds of radiation oncologists say their patients are presenting with more advanced forms of cancer now than they were pre-pandemic. The same share reported COVID-19-related treatment interruptions for existing patients. Nearly three-quarters said their patients missed cancer screenings during the pandemic.
These findings are hardly outliers. An analysis published in May 2020 by the Epic Health Research Network used electronic health records from across the country to track rates of cancer screenings in the early weeks of the pandemic.
That report found that the number of preventive screenings for breast and cervical cancer fell by 94% compared to previous years. Screenings for colon cancer fell by 86 percent.
A follow-up study published in June of this year found that screening rates had increased somewhat but remained below historical levels by as much as 25%.
A separate analysis by the consulting firm Avalere Health in collaboration with the Community Oncology Alliance looked at data on Medicare fee-for-service patients between March and July 2020. It found major reductions in screenings for lung, colon and breast cancer, as well as in cancer therapies and surgeries.
The cause of this fall-off is no mystery. For months, Americans were warned to stay at home whenever possible and avoid healthcare facilities unless absolutely necessary. Even everyday tasks like grocery shopping were seen as high-risk activities.
In such an environment, skipping routine care — including cancer screenings and treatment — might have seemed like a common-sense way to protect against infection. And at least in the early days of the pandemic when little was known about the virus, a better-safe-than-sorry approach was at least defensible.
But forgoing cancer screenings and treatment, even temporarily, is itself high-risk. Cancer and other chronic conditions didn’t take the pandemic off. Indeed, more people died of cancer last year than of COVID-19.
A paper released in April 2020 conservatively estimated that delayed cancer care in the early weeks of COVID-19 would result in more than 33,890 excess deaths in the United States. And that was when the stay-at-home orders were just taking effect.
In an interview with CNBC this month, Novartis CEO Vasant Narasimhan estimated that cancer diagnoses are 30% to 40% lower than they were pre-pandemic.
We must resume our more vigilant posture toward screening for and treating chronic conditions like cancer. That’s even more important as fears about the Delta variant proliferate, and public health officials muse about imposing more restrictions on Americans’ movement and behavior.
As Narasimhan said in his interview with CNBC, “We remain optimistic that even as we go through various waves of COVID that the health-care systems have learned that we need to maintain care for noncommunicable diseases, other chronic diseases.
“Otherwise,” he continued, “in effect we create another epidemic, a syndemic so to speak, of these other diseases.”
We must not let the response to one public health catastrophe, even one as serious as COVID-19, beget another.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All,” (Encounter 2020). Follow her on Twitter @sallypipes. Read Sally Pipes’ Reports — More Here.