July 30, 2020

Pandemic Imperils Cancer Prevention, Screening, and Treatment for Women

By Liz Hay, SWHR Communications Intern

Timely cancer prevention, screening, and treatment is a matter of life or death for women. Yet in the past few months, many women have been hesitant or unable to attend health care visits because of the COVID-19 pandemic, leading to thousands of missed annual wellness visits, vaccinations, and cancer screenings.

Further, women already diagnosed with cancer have had their treatments interrupted by lockdowns and hospital overload. The exact toll of the pandemic on cancer patients will not be clear for many years, but one model estimates an additional 10,000 cancer deaths in the next decade because of the pandemic.

A Slump in Vaccinations

Widespread vaccination against human papillomavirus (HPV) could prevent most cases of cervical and anal cancer. The Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine series be started by both girls and boys by age 11-12.

However, across clinical specialties, pediatricians have seen the greatest decline in visits since the start of the pandemic. As a result, from March through May 2020, it is estimated that children aged 7-18 delayed or missed over 100,000 immunizations, including HPV vaccinations. With potentially many more months of low HPV vaccination rates to come, concerns are growing about future trends for HPV-related cancers.

The Threat to Early Detection

Anxiety over coronavirus transmission in doctors’ offices and hospitals has caused many patients to delay or cancel their routine check-ups. One report found that women were more likely than men to have skipped or delayed appointments due to concerns about coronavirus. Those who didn’t proactively choose to cancel may have their visits canceled as hospitals reduced nonessential appointments to protect patients and preserve resources.

These missed health care visits have drastically decreased the number of cancer screenings in recent months. One analysis showed that breast and cervical cancer screenings fell by 94% in March compared to the 2017-2019 averages. If this trend continues, experts fear long delayed or never rescheduled appointments will result in a surge in more advanced cancer cases.

Early diagnosis is crucial to increase chances of survival. For example, women diagnosed with stage 1 breast cancer have a nearly 100% chance of surviving five years, but that rate drops to 93% for stage 2, 72% for stage 3, and 22% for stage 4. Experts recommend patients talk to their health care provider about when to reschedule appointments to balance the risks and benefits of going in to get screened.

Delays in Treatments

The pandemic has also affected the health of women already diagnosed with cancer. From March to June, patient visits to oncologists dropped 28%. Data from the CDC suggests more than 40% of adults have deferred medical care during the pandemic. Almost one-third of adults have delayed routine care, and almost 12% have deferred emergency treatment. Individuals with underlying medical conditions have been even more likely to delay or avoid care due to their concerns about COVID-19. This presents an immediate threat to women’s health — there is no doubt delaying cancer care is a risk.

However, it’s a risk that must be weighed against the threat of coronavirus transmission in hospitals. Cancer and cancer treatments like chemotherapy can leave patients with weakened immune systems, and the CDC recently updated its guidelines to state that having cancer increases risk of developing severe illness from COVID-19. While hospitals have implemented protocols to protect patients, the National Cancer Institute  (NCI) recommends patients consult with their provider on their unique situation.

Finding Solutions

The COVID-19 pandemic has been an impetus for change in cancer care. For example, telehealth surged during the early weeks of the pandemic, and although many cancer treatments must take place in-person, some visits were able to switch to virtual appointments.

Widespread telehealth practices would require big investments in medical infrastructure and changes to insurance policies, but would ultimately advance women’s health. Research suggests access to telehealth could particularly improve cancer treatment for women in rural areas. At the start of the pandemic, the Centers for Medicare & Medicaid Services (CMS) temporarily extended Medicare coverage of telehealth services, and some policymakers are seeking to make these changes permanent.

In addition to telehealth, the idea of self-screening has gained renewed attention during the pandemic. Recent studies have indicated that self-screening that can be done at home may be an acceptable and effective alternative to clinician-collected samples. “In the post-COVID environment, I think this is a big opportunity to screen women for cervical cancer without having them set foot in a health center,” said Celina Schocken, founder of TogetHER For Health, an organization that works to eliminate cervical cancer.

Delivering health care outside of traditional settings is also becoming more prevalent. In many areas, mobile vaccine units are being explored as a low-contact option to vaccinate children against HPV. The Food and Drug Administration (FDA) is also expediting oncology product development in response to the pandemic and recently approved a new breast cancer treatment that can be administered at home by a health care provider.

The disruption of health care during the pandemic has underscored the urgent need for improved cancer prevention, diagnostics, and treatment options for women. As COVID-19 continues to define our reality, finding ways to mitigate months of missed doctor’s appointments and prevent further delay of care are crucial. Innovations that arise to meet the challenges of this public health crisis could benefit and transform women’s health for years to come.