Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings

Appointments for mammograms and other tests to detect potential cancers were canceled during lockdowns, possibly leading to undiagnosed malignancies. In some cases, the delay has come at a great cost.

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Yvette Lowery with her oncologist before she underwent a double mastectomy.

Travis Dove for The New York Times

By Reed Abelson

• March 17, 2021

Yvette Lowery usually gets her annual mammogram around March. But last year, just as the pandemic was gaining a foothold and medical facilities were shutting down, the center where she goes canceled her appointment. No one could tell her when to reschedule.

“They just said keep calling back, keep calling back,” said Ms. Lowery, 59, who lives in Rock Hill, S.C.

In August, Ms. Lowery felt a lump under her arm but still couldn’t get an appointment until October.

Eventually, she received a diagnosis of Stage 2 breast cancer, started chemotherapy in November and had a double mastectomy this month.

“I’ve been seeing a lot of patients at an advanced stage,” said Dr. Kashyap B. Patel, one of Ms. Lowery’s doctors and the chief executive of Carolina Blood and Cancer Care Associates. If her cancer had been detected last May or June, it would have probably been caught before it had spread, Dr. Patel said.

Months of lockdowns and waves of surging Covid cases throughout last year shuttered clinics and testing labs, or reduced hours at other places, resulting in steep declines in the number of screenings, including for breast and colorectal cancers, experts have said.

Numerous studies showed that the number of patients screened or given a diagnosis of cancer fell during the early months of the pandemic. By mid-June, the rate of screenings for breast, colon and cervical cancers were still 29 percent to 36 percent lower than their prepandemic levels, according to an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

“We still haven’t caught up,” said Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.

Another analysis of Medicare data suggested that as Covid cases spiked during certain periods in 2020, cancer screenings fell. The analysis — conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists — found that testing levels in November were about 25 percent lower than in 2019. The number of biopsies, used to diagnose cancer, decreased by about one-third.

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Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings

Appointments for mammograms and other tests to detect potential cancers were canceled during lockdowns, possibly leading to undiagnosed malignancies. In some cases, the delay has come at a great cost.

“I’ve been seeing a lot of patients at an advanced stage,” said Dr. Kashyap B. Patel, one of Ms. Lowery’s doctors and the chief executive of Carolina Blood and Cancer Care Associates. If her cancer had been detected last May or June, it would have probably been caught before it had spread, Dr. Patel said.

Months of lockdowns and waves of surging Covid cases throughout last year shuttered clinics and testing labs, or reduced hours at other places, resulting in steep declines in the number of screenings, including for breast and colorectal cancers, experts have said.

Numerous studies showed that the number of patients screened or given a diagnosis of cancer fell during the early months of the pandemic. By mid-June, the rate of screenings for breast, colon and cervical cancers were still 29 percent to 36 percent lower than their prepandemic levels, according to an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

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“We still haven’t caught up,” said Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.

Another analysis of Medicare data suggested that as Covid cases spiked during certain periods in 2020, cancer screenings fell. The analysis — conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists — found that testing levels in November were about 25 percent lower than in 2019. The number of biopsies, used to diagnose cancer, decreased by about one-third.