Will COVID-19 launch an epidemic of cancer?
With coronavirus cases spiking, Texas Gov. Greg Abbott has issued an order halting the state’s reopening and banning elective procedures in hot-spot counties.
As more states see viral outbreaks, many governors will be tempted to follow Gov. Abbott’s example. But COVID-19 is not the only threat to public health. Millions of Americans have put off “elective” medical care in order to comply with state orders that they stay home.
Those delays could result in thousands of excess deaths from non-coronavirus causes. To save lives, we need a more nuanced response to the pandemic than blanket stay-at-home orders and bans on elective care.
“Elective” does not mean “optional.” Medical providers classify care as elective, or “non-emergency,” when it can be scheduled in advance. But such treatment is often critical and lifesaving. Elective procedures account for 91 percent of all surgeries in the United States and include things like tumor biopsies, bone marrow transplants, joint replacements and even heart bypass surgery.
The human costs of delaying or canceling elective care are very real. An elementary school teacher in California had to battle severe pain while awaiting a postponed surgery to remove a brain tumor. A Colorado man had to grapple with the possibility of dying after his liver transplant was cancelled in March. Doctors in Washington, D.C., had to cancel a transplant surgery for a 7-year-old boy with a rare kidney disease.
These patients represent just a tiny fraction of those whose medical care has been impacted by coronavirus-related lockdowns. Consider screening and treatment for cancer.
Nearly 2 million Americans are diagnosed with cancer each year. When breast cancer is detected in early stages, the five-year survival rate is 99 percent. But once it has metastasized, survival rates drop to 26 percent.
Similarly, when caught early, colon cancer is highly curable, with five-year survival rates of 90 percent for stage 0 or 1 tumors.
The pandemic and attendant stay-at-home orders have caused patients to put off routine cancer screenings. Mammogram and colonoscopy rates fell between 86 percent and 94 percent in March. One study estimates that during the past three months, more than 80,000 cancer cases have gone undiagnosed.
Missed diagnoses mean missed opportunities for early detection. These delays in treatment and diagnosis will linger far into the future. Cases that were once treatable will become incurable. According to the National Cancer Institute, the United States can expect to suffer 10,000-plus excess deaths over the next 10 years due to delays in diagnosing colon and breast cancers alone.
Coronavirus-related lockdowns also appear to have caused a decline in vaccination rates among children. Government officials estimate vaccinations have fallen by as much as 80 percent.
This is utter folly. Children under 18 account for only 2 percent of COVID-19 cases in the United States, and few develop serious illness. It would be tragic if vaccine-preventable diseases such as measles made a comeback because of unwarranted fear of COVID-19.
Of course, there is risk of COVID-19 transmission during a visit to the doctor. But that risk is not substantially greater than going to the grocery store. Indeed, providers are more likely to wear protective equipment such as masks and gloves and deeply sanitize rooms between patients.
Patients have already endured almost four months of lockdown and delayed care. Even as states reopen, they still face an appointment backlog of up to three months, representing roughly 5 million surgeries.
Our myopic focus on COVID-19 has cost us dearly. Each day we extend the ban or otherwise discourage elective procedures, we deny patients care they desperately need — and increase the chances of unleashing a wave of disease, pain and suffering unrelated to the pandemic.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, Encounter Books, January 2020. Follow her on Twitter @sallypipes.