At the beginning of the COVID-19 pandemic, we saw a dramatic drop in the number of non-COVID-19 medical emergencies. A CDC study found that between March and April 2020, total visits to the ER decreased by 42% compared to the same period in 2019. More importantly, in April 2020, a survey of nine major hospitals showed a decrease in the number of acute heart attacks treated in hospitals. almost 40% in one month. Patients avoided or delayed emergency care for fear of “catching COVID.”
Daily COVID cases in the U.S. are slowly declining since the BA.5 wave. Like emergency room visits and hospitalizations for severe COVID-19. The CDC’s new guidance on mitigating the effects of COVID-19 will encourage the transition to the emergency phase of the pandemic. Emergency room patient volume has returned to and surpassed pre-pandemic levels.
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Unfortunately, too many of my emergency department patients are diagnosed with cancer or tumor progression. These patients are suffering collateral damage from the pandemic; they are more than two years behind on critical illness screening appointments or unable to monitor primary care physician offices in the face of a heavy schedule backlog.
I have recently recommended that people monitor their vaccinations for all the diseases we are commonly vaccinated against. I also want to expedite the most important recent recommendations from the US Preventive Services Task Force (USPSTF) regarding lung, colon, and breast cancer screening.
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Lung cancer: increased screening and fewer smokers have reduced deaths
Lung cancer kills more people in the US than any other cancer. Approximately 154,000 Americans died of lung cancer in 2018. Fortunately, lung cancer deaths are on the decline. This is likely due to:
- By 2020, the number of American smokers will drop from 20.9% (21 out of every 100 adults) to 12.5% (13 out of every 100 adults)
- Increase lung cancer screening
For adults aged 50 to 80 years, with a history of smoking 20 packs per year, and who are current smokers or have quit within the past 15 years, the USPSTF recommends annual low-dose computed tomography (CT) screening for lung cancer. . This annual CT scan should be discontinued only after the person has been smoke-free for 15 years, has a limited life expectancy, or does not want lung surgery.
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Colorectal cancer: Screening begins at age 45
The tragic death of Black Panther star Chadwick Boseman from stage IV colon cancer in 2020 was a wake-up call for many Americans who had never been screened for this rapidly growing disease. Colorectal cancer is the third most common cancer in the United States, and the American Cancer Society estimates that it will cause nearly 52,000 deaths in 2022.
As with lung cancer, the death rate for colorectal cancer has declined due to better screening and removal of precancerous polyps and better treatment options.
The USPSTF made a very important update in May 2021 that both doctors and patients may have missed. As the incidence of colorectal cancer increases among young people, the age to start screening is the same downloaded 50 to 45 years old.
Physicians can screen patients who are at moderate risk (without familial or genetic high-risk factors) using a variety of strategies, including (but not limited to):
- Blood test every year
- Colon CT scan every 5 years
- Colonoscopy every 10 years
- Flexible sigmoidoscopy every 5 years
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Breast cancer: guidelines are not consistent
Breast cancer screening recommendations for women at moderate risk are unfortunately inconsistent and can be a source of confusion for patients.
American Cancer Society guidelines for women at moderate risk for breast cancer:
- Age 40 to 44: May start with annual screening mammography
- Ages 45 to 54: Recommended annual mammogram
- Age 55-plus: Annual or biennial (biennial) screening
The USPSTF 2016 guidelines are currently under revision, and the organization has expressed concern that starting mammography screening for people younger than age 50 may increase the risk of overdiagnosis and subsequent overtreatment. The USPSTF currently recommends screening every two years for women ages 50 to 74.
Notably, a recent survey of more than 600 breast cancer centers found that 80% of them recommend screening mammograms at an age that is contrary to current USPSTF guidelines.
Breast cancer can also affect men. About 1 in 100 people diagnosed with breast cancer in the U.S. is a man—a risk that’s small, but far from zero. About 2,300 men are diagnosed each year, and 500 die.
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Bottom line: If you haven’t seen your primary care doctor during the pandemic, schedule your next appointment. Learn about screening guidelines on the USPSTF website. Be wary of cancer center websites that may omit information about the harms and risks of screening, contrary to USPSTF guidelines. Also, check out ePrognosis, UCSF’s easy-to-use online screening guide.
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Endorsed by Michael Dainno, MD, an ER physician in Los Angeles. He studied Global Health at Georgetown University and holds a medical degree from Ben-Gurion University. He completed his residency in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault