key: cord-0863119-fqlgptjc authors: Printz, Carrie title: Cancer screenings decline significantly during pandemic date: 2020-08-10 journal: Cancer DOI: 10.1002/cncr.33128 sha: 96b750d9933e7720b1b6a20da790aa4a0bc320f5 doc_id: 863119 cord_uid: fqlgptjc nan diagnosed with prostate cancer and 2.5 times more likely to die of it compared with White men. He is critical of recommendations that were based on the PLCO study, which included only approximately 4% of African American men, although African Americans comprise approximately 13% of the US population. "Because their volume of the disease is twice as high as Caucasians, researchers should have increased the number of African American participants to 25% or 26%," he says. He notes that the other major screening study that drove recommendations, the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial, was conducted in Scandinavia, where the Black population is quite small. Furthermore, approximately 80% of PLCO participants in the study received PSA testing at least once during the trial, thereby diluting the impact of its findings, he says. Dr. Folefac is a strong advocate for screening "because we now have the imaging and genomic testing to be able to tell whose cancer will hurt them," he says. He attributes the rising mortality rates to the fact that fewer deadly cancers were detected early enough after the 2012 USPSTF guidance recommended against regular PSA testing. "The lead time before prostate cancer begins manifesting symptoms is about 5 to 10 years, so if we diagnose a patient's cancer while it's still confined to the prostate, his chances of survival at 5 years are nearly 100%. But if we diagnose it after it has spread, the chances of survival are 30%," Dr. Folefac says. Another benefit to early diagnosis and active surveillance is that patients are regularly seeing their physicians, who can talk to them about lifestyle modifications that can improve their health and reduce their risk of developing advanced disease. Dr. Folefac also supports modeling studies that can contribute toward the development of treatment guidelines for specific subgroups of patients. "We need to go back to the drawing board and do the required studies to come up with better evidence for informing guidelines," he says, noting that more must be channeled into this type of research. "We need to invest a lot more in prevention studies, so we have the best quality data, and to stop treating prevention as an afterthought, which is what's currently being done." Findings released in May 2020 by the Epic Health Research Network have indicated an abrupt drop between 86% and 94% in preventive cancer screenings performed nationwide to date in 2020 compared with equivalent weeks from 2017 to 2019. 2 The research assessed screenings for cervical, colon, and breast cancer completed each week from a data set that included 2.7 million patient records from 39 organizations representing 190 hospitals in 23 states. The results demonstrated that cervical cancer screenings declined by 94% whereas colorectal cancer screenings were down 86% compared with the same time period in previous years. "My fear is that all the good that has happened over the past couple of decades is going to go away and that cancers will be caught later at less treatable stages," says Electra Paskett, PhD, director of the division of cancer prevention and control in the department of internal medicine at The Ohio State University College of Medicine in Columbus. "I'm very worried about what we'll be seeing over the next couple of years because of people's reluctance to go in for screenings." In addition to patients being anxious about seeing their physicians or going to health care facilities amid the pandemic, another complicating factor is the number of unemployed workers who now are uninsured and others who have been furloughed and are worried about affording copays, Dr. Paskett says. To better understand why people do not get screened for cancer, she and her colleagues are developing a research project, to be funded by the National Cancer Institute, that will survey individuals with and without cancer, as well as adult cancer survivors. Researchers at Ohio State, 1 of the 5 centers involved with the study, plan to survey approximately 10,000 people. "We want to quantify what people are doing and why," Dr. Paskett says. "Did they lose their job? Are they a caregiver? Did they stay home to help their children with school? Have they started smoking again? Then we can develop interventions to help people cope and take care of themselves." For example, as part of her ongoing efforts to reduce exceptionally high cancer rates in Appalachian Ohio and Kentucky, Dr. Paskett and her colleagues are working to encourage residents to take the home-based, fecal immunochemical test (FIT) for colorectal cancer. The screening test is an alternative to going to a health care facility for a screening colonoscopy, although that still would be required if FIT results are positive. "Even before COVID, we were trying to drive people to get the FIT tests, and it was getting good uptake," Dr. Paskett says. Amid the pandemic, she says, these efforts are more critical than ever. Cancer statistics, 2020 Preventive cancer screenings during COVID-19 pandemic Trends in late mortality among adolescent and young adult (AYA) cancer survivors More Adolescents and Young Adults Are Surviving Cancer, but Little Improvement Noted in Some Cancers A lthough 5-year survival rates have improved for all cancers among adolescents and young adults (AYAs), little improvement has occurred in specific types of cancers since the 1970s, according to a study published in the Journal of the National Cancer Institute. 1 Findings demonstrated that among 282,969 AYA cancer survivors, the 5-year mortality rate (from 5 to 10 years after diagnosis) from all causes declined from approximately 8.3% among those diagnosed from 1975 to 1984 to 5.4% among those diagnosed from 2005 to 2011. However, among patients with specific cancer types, little improvement occurred between those periods. Those types include bone cancer, sarcomas, cervical and/or uterine cancer, and bladder cancer.The diseases for which researchers found some reductions in late mortality from noncancer or nonexternal causes were Hodgkin lymphoma, leukemia, kidney cancer, head and neck cancers, and cancers of the trachea, lung, and bronchus.The main mortality improvements were observed among patients with hematologic malignancies and those with central nervous system tumors, which are predominant in children and have received significant research attention. For example, among AYA survivors of leukemia, the 5-year mortality rate dropped from greater than 25% among those treated during the 1970s and 1980s to less than 5% among those treated more recently.The increase in 5-year survival rates in AYAs most likely reflects advances in therapy for some of the most common cancers in this age group. Long-term surveillance should be a consideration for AYA survivors of the cancers for which mortality rates have not improved, according to lead author Chelsea Anderson, PhD, MPH, a postdoctoral fellow in the Behavioral and Epidemiology Research Group at the American Cancer Society.