Breast cancer, other screenings have been skipped during the pandemic. what do you know. – USA Today


At the start of the COVID-19 pandemic, we saw a sharp drop in the number of patients with non-COVID medical emergencies. A CDC study found that Total emergency department visits decreased 42% from March to April 2020 Compared to the same time in 2019. Most worryingly, a survey of nine major hospitals in April 2020 showed that The number of acute heart attacks treated in hospitals decreased by nearly 40% over one month. Patients were avoiding or delaying emergency room care for fear of “catching COVID.”

Daily COVID cases in the United States from BA.5 . wave back off slowly. So are emergency room visits and hospitalizations for severe COVID-19. The New CDC Guidelines To reduce the impact of COVID-19 reflects a push to move from the emergency phase of the epidemic. Emergency room patient numbers have returned to and exceeded pre-pandemic levels.

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Unfortunately, many emergency room patients have recently been diagnosed with cancer or the development of tumors. These patients suffer collateral damage from the epidemic; They are more than two years late for critical illness screening appointments or have not been able to follow up as their primary care physicians’ offices face a difficult backlog of appointments.

I recently recommended people keep track of their vaccinations In all diseases against which we are usually vaccinated. I also want to make everyone aware of the most important recent recommendations by US Preventive Services Task Force (USPSTF) in connection with screening for lung, colorectal, and breast cancer.

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Lung cancer: Increasing screenings and reducing the number of smokers reduces deaths

More people die of lung cancer in the United States than any other cancer. Approximately 154,000 Americans died of lung cancer in 2018. Fortunately, the number of deaths from lung cancer appears to be declining. This is most likely because:

  1. drop in Number of American adult smokers From 20.9% (21 in 100 adults) to 12.5% ​​(13 in 100 adults) by 2020
  2. Increasing lung cancer screening tests

For adults ages 50 to 80 who have a history of smoking 20 packs each year and currently smoke or have quit in the past 15 years, the USPSTF recommends annual low-dose computed tomography (CT), which is used specifically for lung cancer screening. This annual CT scan should only be discontinued once the person has not smoked for 15 years, or if life expectancy is limited or does not want or cannot have curative lung surgery

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Colorectal cancer: Screening starts now at age 45

The tragic death of ‘Black Panther’ star Chadwick Boseman has stage 4 colon cancer In 2020, it was a wake-up call for many Americans who have never been screened for this fast-growing disease. Colorectal cancer is the third most common cancer in the United States, and the American Cancer Society estimates it will cause it. 52,000 deaths in 2022.

As with lung cancer, mortality from colorectal cancer has decreased due to better screening and removal of precancerous polyps and treatment options.

The USPSTF made a very important update in May 2021 that both doctors and patients may have missed. Because of the high incidence of colorectal cancer among young people, the age to start screening was lowered From 50 to 45 years old.

Clinicians can screen their patients at moderate risk (without familial or genetic risk factors) through a variety of strategies including (but not limited to):

  • Annual fecal blood test
  • CT colonography every 5 years
  • Colonoscopy every 10 years
  • Flexible sigmoidoscopy every 5 years

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Breast cancer: guidelines lack consistency

Recommendations for breast cancer screening for women at average risk are unfortunately inconsistent and may be a source of confusion for patients.

American Cancer Society Guidelines For women at average risk of developing breast cancer:

  • Age 40 to 44: An annual mammogram can begin
  • Age 45 to 54: Recommended annual mammogram
  • Age 55 and over: Annual examination or biennial (every two years)

The 2016 USPSTF Guidelines are currently under review WHO has expressed concern that initiating screening mammography for those under 50 years of age may increase the risk of overdiagnosis and subsequent overtreatment. The USPSTF currently recommends screening every two years for women 50 to 74 years old.

critical note, Recent surveys of more than 600 breast cancer centers It was found that 80% of them recommend screening mammograms at their age of onset contrary to current USPSTF guidelines.

Breast cancer can also affect men. Roughly 1 in 100 people diagnosed with breast cancer in the United States is a man — which means the risk is small, but it’s far from zero. About 2,300 men will be diagnosed each year, and 500 will die.

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Bottom line: If you haven’t seen your primary doctor during the pandemic, make that follow-up appointment. Educate yourself about screening guidelines on the USPSTF website. Be wary of cancer center websites that may differ from USPSTF guidelines and omit information about screening harms and risks. Also check out ePrognosis, an easy-to-use electronic guide to screening from UCSF.

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Michael Daignault, MD, a board-certified emergency physician in Los Angeles. He studied global health at Georgetown University and received his medical degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former US Peace Corps volunteer. Find it on Instagram @dr.daignault

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