At the start of the COVID-19 pandemic, we saw a drastic drop in the number of patients with non-COVID-related medical emergencies. A CDC study found that overall emergency room visits were down 42% from March to April 2020 compared to the same period in 2019. Even more concerning, a survey of nine major hospitals in April 2020 showed that the number of serious heart attacks treated in hospitals had fallen sharply. 40% over one month. Patients avoided or delayed emergency care for fear of “catching COVID.”
Daily COVID cases in the United States from wave BA.5 are slowly declining. The same goes for emergency room visits and hospitalizations for serious illness related to COVID-19. New CDC guidelines to minimize the impact of COVID-19 reflect a push to emerge from the emergency phase of the pandemic. ER patient volumes have returned and exceeded pre-pandemic levels.
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Unfortunately, far too many of my ER patients are diagnosed with cancer or tumor progression. These patients suffer collateral damage from the pandemic; they are more than two years behind in their critical illness screening appointments or have been unable to follow up because their primary care physician practices face a daunting scheduling backlog.
I recently recommended people keep up with their vaccinations for all the diseases that we are commonly inoculated against. I also want everyone to be aware of the most important recent recommendations from the US Preventive Services Task Force (USPSTF) regarding screening for lung, colorectal, and breast cancer.
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Lung cancer: increased screenings and fewer smokers reduce deaths
More people die from lung cancer in the United States than from any other cancer. About 154,000 Americans died of lung cancer in 2018. Fortunately, the number of lung cancer deaths appears to be on the decline. This is probably due to:
- Decline in the number of American adults who smoke from 20.9% (21 out of 100 adults) to 12.5% (13 out of 100 adults) by 2020
- Increase in lung cancer screening
For adults ages 50 to 80 who have a smoking history of 20 packs per year and who currently smoke or have quit within the past 15 years, the USPSTF recommends annual low-dose computed tomography (CT), which is specifically used for lung cancer screening. . This annual CT should only be discontinued once a person has not smoked for 15 years, has a limited life expectancy, or is unwilling or unable to have curative lung surgery
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Colorectal cancer: screening now 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 fast-growing disease. Colorectal cancer is the third most common cancer in the United States. The American Cancer Society estimates it will cause around 52,000 deaths in 2022.
As with lung cancer, the death rate from colorectal cancer has decreased due to better screening and removal of precancerous polyps and treatment options.
The USPSTF made a very important update in May 2021 that physicians and patients may have missed. Due to the increasing incidence of colorectal cancer in young adults, the age to begin screening was lowered from 50 to 45 years old.
Physicians can screen their patients at average risk (without elevated familial or genetic risk factors) with a variety of strategies, including (but not limited to):
- Annual fecal blood test
- Colon CT every 5 years
- Colonoscopy every 10 years
- Flexible sigmoidoscopy every 5 years
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Breast cancer: recommendations lack consistency
Recommendations on breast cancer screening for women at average risk are unfortunately not consistent and can be confusing for patients.
American Cancer Society guidelines for women at average risk of breast cancer:
- 40 to 44: Can start annual mammography screening
- 45 to 54 years old: Annual mammogram recommended
- 55 years and over: Annual or biannual screening (every two years)
The 2016 USPSTF guidelines are currently being revised and the organization has expressed concern that starting mammography screening in people under 50 could increase the risk of overdiagnosis and subsequent overtreatment. . The USPSTF currently recommends biennial screening for women ages 50 to 74.
It should be noted that recent surveys of over 600 breast cancer centers found that 80% of them recommend screening mammograms at a starting age that contradicts current USPSTF guidelines. .
Breast cancer can also affect men. About 1 in 100 people diagnosed with breast cancer in the United States are men, which means the risk is low, but far from zero. About 2,300 men will be diagnosed each year and 500 will die.
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Bottom Line: If you haven’t seen your GP during the pandemic, schedule that follow-up appointment. Learn about screening guidelines on the USPSTF website. Beware of cancer center websites that may diverge from USPSTF guidelines and omit information about the harms and risks of screening. Also check out ePrognosis, an easy-to-use online guide to UCSF screening.
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Michael Daignault, MD, is a Los Angeles Board Certified Emergency Physician. He studied global health at Georgetown University and holds a medical degree from Ben Gurion University. He completed his emergency medicine residency at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault