Pandemic slows early cancer detection and follow-up care

It is not uncommon for tumor patients to have to give way to covid patients when it comes to intensive care beds and personnel. But the corona pandemic is also slowing early detection and follow-up care – with serious consequences.

A mammogram shows a tiny tumor in a patient's breast

Heidelberg – The corona pandemic not only affects acute care for cancer patients, but also leaves deficits in early detection and follow-up care, experts say.

"Here we will still experience a difficult situation in one or two years," says Susanne Weg-Remers of the German Cancer Research Center (DKFZ) in Heidelberg. They understand the reluctance to go to a doctor’s office or hospital for screening only. "Out of fear of infection, a number of people do not take advantage of early cancer diagnosis." So mammography and colonoscopies would be used much less than before the pandemic.

The president of the German Cancer Society (DKG), Thomas Seufferlein, gives the all-clear to hesitants: "The majority of corona infections do not happen in clinics and practices, but in the private sphere, because people tend to forego protective measures there."

Early detection not an issue for many

In the view of the two experts, early cancer detection helps to identify tumors when there is still a good chance of a cure. "Preliminary stages can also be recognized," Weg-Remers explains. This is especially true for colorectal and cervical cancer, they say. But these benefits were less important to some people than the risk of corona infection. "We will have to deal with more advanced cancers in the coming years," the physician is certain.

Many Germans do not take advantage of early detection offers anyway. According to the AOK, a relevant proportion of its eligible insureds have not been reached by early cancer detection over a ten-year period, or only to a limited extent. And during the pandemic, according to the health insurer, there were slumps in early cancer detection that raised fears of health consequences. There were particularly sharp declines of nearly 20 percent in skin cancer screening in 2020, with a continued downward trend in early 2021. Declines in participation rates compared to 2019 of 8.1 percent each were seen in mammography screening and prostate cancer screening. For cervical cancer screening, it was minus 5.5 percent.

More delayed diagnoses

Barmer confirms a similar trend: surgical interventions for cancer fell by 26.3 percent in 2020, according to the health insurer. Radiation therapies recorded a drop of 28 percent. Even in 2021, the pre-Corona level has not been reached again, says Ursula Marschall, chief medical officer of Barmer. In terms of early detection, it assumes that 71.000 people in Germany received no or a delayed cancer diagnosis, including 11.000 breast cancer patients and 9000 people with melanoma. Marschall sums up: "We assume that cancer mortality will rise significantly as a result."

In a Forsa survey commissioned by the AOK, one in five said in May 2021 that they were unable or unwilling to go to one or more cancer screenings because of Corona.

DKG President Seufferlein also points to the drop in early detection: "People avoid cancer screening not only out of fear of Corona infections, but because they do not want to place an additional burden on the healthcare system."Especially for common cancers such as breast, colorectal and ovarian, the uptake of screening was reduced at the beginning of the pandemic," he said.

Follow-up care also suffers from Corona

Andreas Schalhorn, a long-time oncologist, appeals to anyone with the slightest suspicion of a tumor to clarify the issue despite Corona: "Under no circumstances should the clarification be postponed." Munich physician advises full Corona immunization to minimize potential risk of infection during exams.

But things are not going well with cancer aftercare either, says Seufferlein, medical director of internal medicine at Ulm University Hospital. "In the peaks of the pandemic, the number of follow-up patients has also dropped by 30 percent."This is regrettable because aftercare – i.e. ongoing medical and psychosocial support – is very important in the first five years after a tumor has been removed, after which the risk of a relapse decreases significantly. According to Weg-Remers, a quarter fewer cancer follow-up appointments were made at the cancer centers of the university hospitals in Germany in December 2021 than before the pandemic.

The declines in diagnoses are also reflected in a decline in cancer operations. For example, based on AOK billing data, the pandemic period from March 2020 to July 2021 shows a 13 percent decrease in the number of colorectal cancer surgeries and a 4 percent decrease in breast cancer surgeries compared to 2019. According to the AOK, this may be reflected in the medium term in a higher proportion of more severe diseases – and thus have an impact on mortality. Cancer is the second leading cause of death in Germany: over 231.000 people died from them in 2020.

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