CHICAGO — As people avoided hospitals during the pandemic and nonurgent appointments were canceled, something skipped by many were routine screening appointments like Pap smears or breast exams.
A year later, doctors are starting to see the results of missed screenings and asking patients to return to routine appointments.
The Centers for Disease Control and Prevention recently announced that screening tests received through the CDC’s National Breast and Cervical Cancer Early Detection Program declined by 87% for breast cancer, and by 84% for cervical cancer during April 2020 compared with the previous five-year averages.
The study, which examined data from the agency’s program that provides cancer screening services to women with low income and inadequate health insurance, is concerning because fewer screenings can lead to delayed diagnoses and an increase in cancer among women already facing health disparities.
“When the pandemic hit, we already had this disparity, and the pandemic just made it worse,” said Dr. Summer Dewdney, director of the division of gynecologic oncology at Rush University Medical Center.
Dewdney said many patients missed the annual exam with their obstetrician that can include a Pap smear, which can flag early cases of cervical cancer. Between a Pap smear and the HPV vaccine, she considers cervical cancer an almost preventable disease.
At Northwestern, Dr. Sarah M. Friedewald, chief of breast imaging at Northwestern Memorial Hospital, said their screening rates are nearly back to pre-pandemic levels, but this still involves many patients who missed last year’s appointment.
“A lot of people skipped,” she said. “A lot of people are coming back now, but they skipped 2020.”
Even a six-month delay in screening could lead to an increase in deaths from breast cancer based on modeling studies, Friedewald said. In recent weeks, she said, their pathologists have noticed the percentage of positive biopsies has increased. It’s hard to know why that is, whether it’s because they are prioritizing testing after screenings that look highly suspicious, or if it is due to patients who have more concentrated cancer because they skipped a year.
Last year, Friedewald said screenings slowed down and almost completely stopped from March through June. Those people are now due the next year for their screening, and may have completely missed last year.
“The overall screening rates are rebounding, but women of the minority populations are not rebounding as much,” she said.
Reasons people skip screening could include a fear of getting COVID-19 at a hospital (Friedewald emphasized hospitals are safe), preferring outpatient centers to hospitals or, Friedewald said, “people are putting their own health care on hold and focusing on other people in their family, making sure everyone is healthy before focusing on themselves.”
A delay in screening can mean catching cervical cancer when it has progressed more, Dewdney said. Groups that help women get free screenings include Equal Hope, a health equity nonprofit aimed at eliminating cervical cancer disparities and eventually eradicating the disease.
Friedewald encourages patients to pay attention to routine screenings and not delay them.
“We need patients to come in as soon as they can,” she said.