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Skip cancer screenings during COVID? Doctors want patients back in routine to catch issues early
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District program manager Sophie Xie works at her desk inside the Hall County Health Department Thursday, Sept. 24, 2020. Medical professionals in the cancer field are concerned about a drop in screenings due to COVID-19, because people are nervous about being at medical facilities during the outbreak. - photo by Scott Rogers

When the COVID-19 pandemic hit, Dr. Brad Auffarth said some women fell out of the routine of receiving annual breast cancer screenings. 

“I have definitely seen several breast cancers that were from delay and they sort of got lost in the process,” Auffarth said.

Screenings of other types of cancer fell off, too.

Regarding the patients seen at Northeast Georgia Physicians Group’s radiation oncology departments in Gainesville, Toccoa and Braselton, Dr. Geoffrey Weidner said they saw 10% fewer new patients between 2019 and 2020. Since then, however, the rate of new patients has risen roughly 5%.

“Personally, I’ve seen patients in the past year end up with incurable cancers due to delays in their diagnosis or screening, so that’s why I think it’s important for the message to get out there that screening does save lives,” Weidner said.

Weidner said the cancers most proven to have better outcomes from screening are breast, colon, lung and cervical.

“As more people get used to the idea of COVID being around, we’re starting to see more patients come back for screening and having any cancers detected earlier when they’re more curable and require less intensive treatment,” Weidner said.

Between Longstreet Clinic and Northeast Georgia Health System, health care officials are trying to not only increase the number of breast cancer screenings but also expedite the process after a woman has received an abnormal mammogram.

Angie Caton, Northeast Georgia Medical Center’s cancer services project leader and assistant nurse manager, said the health system was approached earlier this year to be part of a nationwide program through the American Cancer Society. With $20,000 in grant funding, the goal is to increase breast cancer screening by 10% of pre-pandemic levels between June and November. That means the goal is 2,394 screening mammograms each month.

Women between the ages of 40 and 49 should receive either annual or biannual screening for breast cancer with annual screening when 50 or older, Caton said.

The health system was 27 screenings below the goal in June but exceeded the benchmark in July and August. 

Their methods have been to reduce barriers for women — whether it is language, transportation or finances — that are in high-risk populations, Caton said.

Some medical professionals have provided information in Spanish, Vietnamese, German, Russian, Ukrainian and Arabic to reach people in their native languages.

“We thought if it came from female providers speaking their language, that might be a very good thing,” Caton said.

When Auffarth started his medical practice, the rate of breast cancer in women was 1 out of 12. Now, it has grown to 1 out of 8. 

Auffarth, a Longstreet Clinic general surgeon, has taken a leadership role in advancing the breast cancer program and expediting the process.

“Between the time that you hear you have an abnormal mammogram to when you have a plan for how to manage it if it is a breast cancer, (that) is a really stressful time,” Auffarth said.

What may have been weeks before is now down to a matter of days, said nurse practitioner Lisa Logue.

“Once patients come referred to us and have an abnormal mammogram, our goal is to get patients seen at least by me within a day or two so they have their schedule,” Logue said. “If they need a biopsy, they are set on the schedule. Oftentimes, their biopsy can be done the same day unless the physician is out of the office. When we say expedited, we’re not talking two to four weeks for all of this to happen. We’re talking one or two days.”

Auffarth said there is a high proportion of women coming for screening that have a family history of breast cancer, but he feels they are missing women without that history that still should be screened.

Sophie Xie, who runs the breast cancer and cervical cancer program at District 2 Public Health, told The Times last year they noticed a drop in screenings between February to June of 2020 compared to the same time period in 2019. Xie was unavailable for a follow-up interview.

"We did have some barriers in the early stages of COVID because we didn't have providers that were able to open their labs that we refer our patients to,” Xie previously told The Times. “They were closed or only providing essential services."

Xie provided information about other cancer screenings; cervical cancer screening is recommended every three years for women ages 21-30 and women ages 30-65, should still get cervical cancer screening every three years along with human papillomavirus co-testing every five years. 

Men and women ages 50-75 should get screened for colorectal cancer. Men over the age of 50 should get their prostate checked, and Caton said the guidance starts at 45 for Black and Hispanic men. 

Lung cancer screening is considered the “new kid on the block,” Caton said, as mammograms, colonoscopies and other screenings have been around for much longer.

In April 2020, the number of lung cancer screenings at NGMC dropped to just two. In August of this year, it is up to 119 screenings.

Of the 856 scans performed by NGMC in 2019, there were 14 lung cancers diagnosed, with 10 of them being at early stages. In 2020, there were 10 lung cancers discovered in 909 scans, and half of those were at early stages.

Through August of this year, NGMC has already performed 809 lung cancer screenings and detected 10 lung cancers, eight of them being at early stages.

NGMC has set an organizational goal to increase lung cancer screenings by 10%, which they are set to exceed if this trend continues.

A low-dose CT screening site opened in Dawsonville earlier this year that has already performed 50 scans, Caton said.

Low-dose CT scans are performed without a dye injection and take roughly 10 minutes, which means a “remarkable decrease of radiation,” Caton said.

“If you’re getting these every year, the average person would be exposed to a lot of radiation if they received a full CAT scan every year,” Caton said.

Despite the resurgence of COVID-19 this year, the number of lung cancer screenings have remained steady, according to data provided by Caton.

“I think, as a nation, we’re trying to be more proactive about this instead of just waiting for people to show up with the cancer, trying to catch them early when things will be easier to treat and they won’t lose their lives,” Caton said.