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Screenings For Cancer Dropped Dramatically During The Pandemic

NOEL KING, BYLINE: Many of us should be testing regularly for various forms of cancer - colorectal, breast, prostate, cervical. That's what the CDC recommends. But during the pandemic, these kinds of screenings plummeted. And now doctors say they're diagnosing later-stage cancers that could have been caught earlier. And they say many patients haven't yet resumed getting their checkups. NPR's Yuki Noguchi has been looking into this. Hi, Yuki.


KING: So the stakes here are pretty high for people's health. How much did the pandemic affect screening for cancer?

NOGUCHI: Yeah, so early on in April of last year, the CDC says cancer screenings declined nearly 90%. Even today, things remain far off normal. And, you know, screening can detect cancers early when treatment is easier and more effective. But, of course, for many people last year, the fear of COVID overshadowed fears of cancer.

KING: Is this changing as more people get vaccinated?

NOGUCHI: Yeah, it's starting to, but given the big backlog, doctors say they should be seeing many more patients. Another huge concern is that people who live in rural areas, Latino, Black and other patients of color are all more likely to have missed, postponed or canceled screenings. And once again, these are communities where accessing health care is and really always has been challenging in so many ways.

KING: How big a deal is it to miss or delay an appointment?

NOGUCHI: You know, if it's only a few months and you're at low risk, it's not likely that dangerous. But delays tend to ripple out, throwing people off schedule. And modeling data from the National Cancer Institute shows that last year's drop in testing for breast and colorectal cancer alone will lead to 10,000 additional deaths over the next decade. It's like a hidden toll of the pandemic. And the problem is, you know, once you skip a pap smear, say, then you might not get the reminder to schedule your next exam. Or maybe you moved or lost a job and don't have a primary care doctor, you know, keeping tabs on you. So, in short, many people don't know which screenings they should be getting. And that's what worries doctors like David Cohn, who's chief medical officer at the James Cancer Center at Ohio State University. A skipped appointment, he says, too easily stretches into years, and that's risky.

DAVID COHN: That's when we're going to start to see a dramatic rise in either the number of cancers that are diagnosed. Or those that are diagnosed are going to be diagnosed later.

NOGUCHI: I spoke with a woman exactly in that situation. Her name is Pam Nelson (ph). She raised four boys on a sprawling converted campground on the western edge of Pennsylvania, where bears trudge through and chickens roam.

PAM NELSON: It's farm country, and the kids drive their tractors to school on prom day.

NOGUCHI: Normally, Nelson drives an hour and a half in a car, not her tractor, to get mammograms every year.

NELSON: About 12 years ago, I had breast cancer - found by mammogram, thank goodness.

NOGUCHI: But last year, the pandemic delayed her appointment until October. That revealed a mass the size of a penny. Further evaluation took longer, also because of the worsening pandemic.

NELSON: It was December before I could get biopsies because everything is all jammed up. So you had to wait an entire month.

NOGUCHI: Nelson couldn't schedule her lumpectomy until late January. Had it not been for the pandemic, she says...

NELSON: I think it would have been found at a smaller stage.

NOGUCHI: So, Noel, imagine that kind of scenario playing out for many people.

KING: Yeah, I can see the extent of the problem in that one story. And then you said, Yuki, that these kinds of delays are affecting people of color disproportionately. Why is that?

NOGUCHI: Yes. The Prevent Cancer Foundation just released a survey this month showing Latino patients are 30% more likely to have missed or postponed screenings than white patients. And Black patients are 19% more likely to have missed their screenings. Jody Hoyos is the president of the foundation. She says this.

JODY HOYOS: But I think it's just an exacerbation of the same barriers we see all the time.

NOGUCHI: You know, barriers like lack of insurance or shortage of doctors, especially in remote areas. But also, busy work schedules can get in the way or not having a car.

KING: What can doctors and hospitals do about this if there's nothing that patients can do about it?

NOGUCHI: Well, you know, structural issues of insurance are hard to address. But on the practical side, some cancer centers are trying to offer free transportation or paying for parking. I talked to Karen Knudsen, who's the CEO of the American Cancer Society. Before that, though, she was director of oncology at a cancer center in Philadelphia. And she says centers around the country are trying to bridge those gaps in care.

KAREN KNUDSEN: When we started opening mammography on the weekends, we found that it was one of the most popular times to get your mammogram.

NOGUCHI: The center where she worked also now sends mobile medical units into neighborhoods where screening rates are low.

KING: And when we talk about inequality in access to health care - you and others at NPR have done reporting on this - we are not just talking about logistics. There are some cultural divides or differences here.

NOGUCHI: Yeah, that's right. There's a deep skepticism about medicine in parts of these communities. And I've talked to patients, even a doctor who say they felt ignored, dismissed, even shamed about their bodies by physicians. And they felt it was because of their race. And that's a deterrent, you know? Kavita Jackson is 33, an Indian American. Her breast cancer diagnosis came right as the pandemic began. She's a doctor, so she can advocate for her own care. But she's seen others struggle.

KAVITA JACKSON: I've seen many other women been completely turned away. Oh, you're only 30. Oh, no, this doesn't affect you. People getting turned away are not being taken seriously.

NOGUCHI: Jodi-Ann Burey says that's why she started a podcast called "Black Cancer" during the pandemic. For two years, she said, doctors dismissed her cancer symptoms. The podcast, she says, is her way of advising others to persist through those roadblocks.

JODI-ANN BUREY: Trusting yourself, screenings, genetic testing - I think we need as much information as possible, particularly people of color.

NOGUCHI: She says patients really need to take control, educate themselves about which screening they need and then advocate for their own care because otherwise, they risk falling through the cracks.

KING: Yeah, that sounds like good advice. NPR health correspondent Yuki Noguchi. Yuki, thank you so much for your reporting.

NOGUCHI: Thank you, Noel.

(SOUNDBITE OF HELIOS' "VAINGLORY") Transcript provided by NPR, Copyright NPR.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.
Noel King is a host of Morning Edition and Up First.
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