Coronavirus: Doctors worry about Ontario’s low rate of cancer screenings during pandemic

While the potential for variants of COVID-19 to wreak havoc on our summer dominated most headlines from the province’s release of new pandemic modelling data, it is hard to ignore some of the disturbing numbers around cancer screenings in Ontario’s hospitals.

Officials reported cancer screenings sank to nil in April and May, but the tests still remain well below pre-pandemic levels.

According to statistics gathered by Ontario Health, almost a million fewer colorectal, breast and cervical cancer screenings were conducted between March and December than were carried out through the same stretch in 2019.

Hospitals conducted 1,949,620 during that span in 2019 compared to 952,355 through the same, pandemic-affected period in 2020.

“Combine this with the likely rise in chronic disease associated with unemployment and our health system will need to be ready to handle a prolonged and substantial surge in the demand for post-pandemic care,” warned Dr. Adalsteinn Brown, the co-chair of Ontario’s COVID-19 Science Advisory Table, during a news conference on Thursday.

Displaying a graph showing life-saving colorectal, breast and cervical cancer screenings rising from the last spring’s standstill and dipping again late in 2020, Brown tempered his optimism.

“(Cancer screening) has started to come back up again, but is not yet at pre-pandemic levels,” he said.

“It’s important to note, again, although some of these cancers do grow very slowly … when we miss screenings, we miss cases, cancers progress, and again we will need to deal with the consequences of this in terms of increased morbidity.”

Doctors said the current situation is a two-pronged problem: COVID-19 is eating away at hospital resources and the ability of medical staff to do timely cancer screening, and some patients are afraid to see doctors for fear of getting infected. Either way, the chances of catching cancer in early, less harmful stages drops.

“Our screening has been far, far less than normal,” said Dr. Shady Ashamalla, the head of the general surgery division at Sunnybrook Health Sciences Centre and a specialist in colorectal cancer.

“It makes perfect sense that we’re going to be seeing cancers much further along in their natural history, and that’s very consistent with what we’re seeing in clinical practice.”

Dr. Fei-Fei Liu, the chief of Princess Margaret Hospital’s radiation medicine program, said staff have managed to get screenings back to within 10 to 15 per cent of their pre-COVID rate, but it didn’t come without its share of difficulty.

“Breast cancer is my area of specialty,” explained Liu.

“In the beginning part of last year, we saw very few patients with early-stage … ductal carcinoma in situ, which the majority of these patients are picked up through mammography. But in the recent few months, we are seeing those patients and those patients do very well.”

She admitted for patients that may have other forms of cancer, “it does worry us a little bit in terms of the time of diagnosis and time of treatment.”

Ashamalla said fixing this situation and getting back to “baseline screening” is going to be tough.

“The first step is prevention … We know that if we let this (pandemic) rip right now, we’re going to fill the hospitals again,” he said.

“We have not vaccinated enough of the province of Ontario that we can say the hospitalization rate of COVID has changed.”

Ashamalla said obeying public health guidelines and continuing with vaccination efforts, reaching a level where an increase in cases doesn’t mean a jump in hospitalizations, is the way out.

“The patients of Ontario need operating rooms running, and that’s not just for COVID patients or for the elderly or for patients in long-term care,” he said.

“Everybody in Ontario needs a functioning health-care system.”

While the Ford government deals with that aspect, cancer care experts said patients also need to conquer their fears of the virus and see a doctor if they feel off. It is more important to rule out an even worse scenario.

“Signs and symptoms of cancer could be the sign of something not serious, but it could be cancer,” said Elizabeth Holmes, a senior manager with the Canadian Cancer Society.

“It’s a doctor or a health care team that can help you determine whether it is something more serious.”

Many hospitals have taken several steps to make sure patients are seen or treated as quickly and as safely as possible.

“We undertake a very, very vigorous protocol in terms of screening patients who come into the cancer hospital,” said Liu.

“We actually have a COVID swabbing done for all of our patients before they undergo any of the cancer treatments.”

Liu said the hospital has also found ways to reduce the risk of COVID-19 infection by making evidence-based reconfigurations to radiation therapy, making treatment more efficient, and limiting the amount of back-and-forth trips necessary.

“We’re extremely attentive and so the hospital is one of the safest places actually when it comes to COVID,” she said.