The pandemic has disrupted preventive health care. Here's how to get back on track
Have you overlooked or postponed your health checkups during the unending 20-month pandemic?
A new study suggests that U.S. cancer diagnoses have declined because of pandemic-related upheaval. The average monthly number of newly identified cases of eight types of cancer plunged almost 30% during the early pandemic shutdowns, then rebounded when medical practices reopened—but fell again last winter by 19%.
Skipping screenings and checkups could lead to diagnosis of cancer at later stages, which could lead to poorer outcomes, the study authors wrote last month in JAMA Network Open.
And it's not just cancer. The pandemic has disrupted diagnosis and preventive care of diabetes, high blood pressure, high cholesterol, heart disease, depression, and many other conditions, especially for those who struggled to access quality care before the pandemic.
"We know that COVID-19 unfortunately shed a light on the many disparities in health care that existed—and then it added another," said Delana Wardlaw, a Temple Health primary care physician who was named 2020 Pennsylvania Family Physician of the Year. "People who have poorly controlled or undiagnosed illness are at higher risk of severe COVID-19 and death."
A year ago, Wardlaw and her twin sister, pediatrician Elana McDonald, launched TwinSisterDocs—accessible at TheTwinSisterDocs.com, and on Twitter, Facebook, and Instagram—to promote wellness, self-advocacy, and address health disparities in the underserved communities where they have worked for two decades.
Jefferson Health's Sidney Kimmel Cancer Center also recently launched an effort to better serve vulnerable populations in the Philadelphia region: a mobile cancer screening van funded with a $1.4 million gift from Dietz & Watson, the delicatessen meat maker. Initially, the mobile unit is offering mammograms to detect breast cancer, but will eventually offer screening for prostate, head and neck, and skin cancers. It will also connect patients to cancer resources, such as smoking cessation programs and cancer clinical trials.
If you have no particular pains or problems, it is easy to adopt the attitude that "it's not broken, so don't fix it." But a healthier attitude is, "You can't fix what you don't know about."
Here is a rundown of preventive health screenings you should get, even in a pandemic:
No one wants a colonoscopy, but this screening test truly prevents colorectal cancer because the physician can find and remove precancerous polyps.
A first colonoscopy is now recommended at age 45, instead of 50, because colorectal cancer has been increasing among younger adults, especially in Black patients. "We definitely want to make sure people are getting colonoscopies," Wardlaw said.
The interval for a repeat colonoscopy varies, depending on risk factors and the results of the first screen.
If you're at average risk, stool tests are at-home alternatives for screening, but positive results mean you need a colonoscopy.
For women, breast and cervical cancer screening guidelines have evolved. Leading organizations say that average-risk women age 55 and older can get mammograms every two years, rather than annually, if results show no evidence of cancer. So you may be within the recommended interval, even if you skipped your mammogram last year.
Pap smears, which used to be done annually, are no longer recommended more often than every three years. And if you add a screening test for HPV, the virus that causes cervical cancer, you can wait five years after normal results to screen again.
Prostate cancer screening advice has also changed. Men should talk to their doctors about the pros and cons of routine PSA blood tests. For higher risk men—that includes Black men—screening may be prudent. But experts say the risks of detecting and treating an inconsequential tumor should be discussed.
Skin cancer—including melanoma, the most dangerous kind—is linked to sun (and sunlamp) exposure, skin type and age. If you are fair skinned or have been treated for basal or squamous cell skin cancer, monthly self-checks and annual checks by a physician are a good idea. Rates of all types of skin cancer have been rising for 30 years.
For that JAMA Network study of the decline in cancer diagnoses, researchers from Quest Diagnostics used records of newly diagnosed cancer patients who received testing at Quest. In the year before the pandemic hit, the monthly average of new diagnoses was 32,000. In the most recent period, November 2020 to March 2021, the monthly average was about 26,000—suggesting thousands of people skipped screening tests or checkups in the last year.
Other screening tests
Routine blood pressure and blood cholesterol checks are important because abnormal levels usually cause no symptoms—until cardiovascular damage develops.
The same for diabetes, which can damage organs throughout the body if not diagnosed and controlled. Many people with high blood sugar don't know it because they haven't had an A1C test to check their level after fasting. So-called prediabetes can often be reversed with improved diet and weight loss. If it progresses to diabetes, "make sure you get your A1C checked," Wardlaw said. "If you need medication, it can be initiated, or adjusted."
Thyroid function tests are usually done based on symptoms or because a doctor feels a lump at the base of the neck, where the gland is located. A surprisingly varied list of symptoms, including weight loss or gain, heart flutters, severe constipation, and hand tremors, may signal thyroid problems. The American Thyroid Foundation says adults over 35 should be checked once every five years.
Bone density screening for osteoporosis, done with an X-ray called DEXA, is recommended for women at age 65 and for younger women with certain risk factors, including having a parent with a history of hip fracture. The Centers for Disease Control and Prevention suggests using the FRAX Risk Assessment tool to see if you should have a DEXA scan. A number of osteoporosis medications are available.
Shots to ward off the flu, pneumonia, and shingles are highly recommended for adults.
So, of course, is the COVID-19 vaccine. If you are hesitant, talk to a trusted doctor to understand how getting vaccinated protects you and your loved ones (including children too young to be vaccinated), while contributing to the global goal of ending the pandemic. The Twin Sister Docs have worked tirelessly to reassure and persuade their hesitant patients, even making a video with Walgreens.
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