"A tsunami of cancer"

[George K]

https://www.cbc.ca/news/health/cancer-tsunami-screening-delays-covid-1.5844708

"What we're worried about, of course, is that there may be a tsunami of cancer out there that's going to suddenly show up," said Dr. Keith Stewart, director of the Princess Margaret Cancer Centre in Toronto.

Cancer specialists are worried about the significant drop in the number of cancer screening, referrals and diagnoses in Canada since the pandemic began in March.

It doesn't mean that cancer rates are dropping — experts say it means that cases are being missed and people aren't getting the treatment they need.

During the first wave of the pandemic — from March 15 to May 31 — there was a significant decrease in screening for three major cancers in Ontario compared to the same period in 2019, according to Ontario Health:

• A 97 per cent decrease in screening for mammograms through the Ontario Breast Screening Program.

• An 88 per cent decrease in Pap tests through the Ontario Cervical Screening Program.

• A 73 per cent decrease in fecal tests through ColonCancerCheck.

Alberta Health says the number of Albertans diagnosed with cancer decreased by 23 per cent for the period of March to September 2020 as compared to the same period in 2019.

In British Columbia, screening and diagnostics such as imaging and biopsies were scaled back from March to June, according to the chief medical officer at B.C. Cancer.

There was a decrease of about 25 per cent in cancer diagnoses, said Dr. Kim Nguyen Chi, both in cancers it would normally screen for, such as breast, colorectal and cervical, but also cancers it doesn't routinely screen for, because people weren't necessarily accessing the health care system.

According to a recent editorial in the British Medical Journal, the delays in diagnoses will have tragic outcomes.

Citing a British study, it said that for four common types of cancer — breast, bowel, lung and esophageal — delays in diagnosis due to the COVID-19 pandemic would result in approximately 3,500 avoidable cancer deaths in England.

(Those figures do not consider the impact of delays in initiation of treatment or changes in treatment schedules.)

Doctors worry similar impacts could be felt in Canada.

"During the initial days of the pandemic, when everything went into lockdown, we stopped operating on non-urgent cases and we gave some patients chemotherapy instead of surgery," while they waited for a delayed operation, said Stewart.

Speaking from personal experience, I have not experienced this - yet. Mrs. George had a shoulder replacement in August (with post-op complications that were dealt with expeditiously). She's scheduled for a mammogram in early January, and I'm planning my next colonoscopy as well.

[Rich]

I know a couple folks that have had surgeries put off. One, who by the time he is able to get in, will have been delayed almost a year.

A running injury, that still allows him to get through the day and function..even some 'light' running....but won't ever heal without surgery.

Probably the very definition of an elective surgery, and not nearly as serious as a missed cancer diagnosis, but it would only seem to make sense that with fewer in-person visits and screenings, there will some cases caught much later than otherwise would have.

The joys of 2020 may linger for a bit..

[George K]

A surgeon friend once said to me that there are three types of operations:

1. Operations that need to be done next month
2. Operations that need to be done tomorrow
3. Operations that need to be done now

As far as orthopedic things go, I think #1 is a bit restrictive (think joint replacement). Other things, like hernias, breast biopsies, cystoscopies...maybe two months is OK.

[Copper]

@george-k said in "A tsunami of cancer":

I'm planning my next colonoscopy as well.

Mine is a week from Monday.

It has been 5+ years, my understanding is that it is still unpleasant.

[George K]

@copper said in "A tsunami of cancer":

my understanding is that it is still unpleasant.

You need an anesthesiologist to give you some propofol. It was a piece of cake.

The prep, however...well, that's something else, of course.

[Copper]

@george-k said in "A tsunami of cancer":

The prep, however...well, that's something else, of course.

Yes, the prep

The times I had it before, I have been out cold for the procedure. That was no problem.

[Mik]

I was wide awake for the procedure despite a double dose of Versed and Demerol. i was barely buzzed. I have always been hard to sedate without propofol. The procedure is not bad even awake, but then these things interest me. I know what my innards look like.

But put off diagnostics? We have not done that.

[Renauda]

I have it from good authority on cancer related issues locally, is that a lot people who started to experience symptoms last winter either ignored them entirely or sought alternate medicines to relieve the symptoms. They were too afraid to see or consult with the family doctor about the symptoms.

The result is that now there is indeed a tsunami of advanced stage cancers showing up requiring either emergency surgeries or oncology treatments. Some particularly nasty head and neck cancers that require immediate surgery and aggressive radiation follow up have become disturbingly common. Unfortunately owing to the latest Covid crisis, surgeries are difficult to schedule and these people are left with only chemo or radiation as immediate options.

Needless to say the prognosis for many of these folks is not good.

[bachophile]

I’ve seen a number of delayed diagnosis because of COVID but they are the exception not the rule.

Our screening programs continued unabated during lockdowns. Screening was considered an essential service.

[Renauda]

Cancer screening programmes and procedures have never been affected here either. At least not until, perhaps, the past month. I certainly experienced no delays last spring when such really mattered.

[Copper]

@george-k said in "A tsunami of cancer":

You need an anesthesiologist to give you some propofol.

She did

Excellent stuff, really nice, home now I'm still feeling it

3mm polyp removed

See you in 5 years