Diagnoses Delayed: COVID-19's Impact on Cancer Patients Revealed

The impact of delayed cancer screenings during the COVID-19 pandemic is now becoming clear ― and the news isn’t good. Researchers at Baptist Health Miami Cancer Institute have discovered a significant increase in the number of cancers found at a more advanced stage in the months after the pandemic compared to before it.

During and following the pandemic, in-person cancer screenings were either unavailable or had limited appointments, and many patients, out of fear or other problems, postponed their tests. The study, titled “The Impact of COVID-19 on Patients Diagnosed with Melanoma, Breast, and Colorectal Cancer,” and published recently in the American Journal of Surgery, was a collaboration between Miami Cancer Institute and the Herbert Wertheim College of Medicine at Florida International University (FIU).

Baptist Health and FIU announced last spring the formation of a comprehensive alliance that will enhance the university’s medical school, provide training for new physicians and other health professionals, and expand clinical research. The first author of the study, Danielle Hanuschak, will graduate from the medical school in 2024.

Geoffrey Young, M.D., chief of head and neck surgery at Baptist Health Miami Cancer Institute and vice chair of the Department of Surgery at Florida International University's Herbert Wertheim College of Medicine

“We know that cancers found at an earlier stage tend to have more treatment options and better outcomes,” says Geoffrey Young, M.D., chief of head and neck surgery at Miami Cancer Institute, vice chair of the Department of Surgery at FIU, and the study’s corresponding and senior author. “But our initial discussions about what would happen when people couldn’t get colonoscopies or mammograms were all theoretical. We wanted to see if our theories would bear out over an extended time.”

Joining Dr. Young in the research was a team of Institute informatics experts and statisticians. Similar studies conducted by other organizations have primarily focused on one specific cancer or cancer screening numbers and diagnoses in the initial months of the pandemic. But the Institute study went further, looking at more than 4,000 patients diagnosed with breast cancer, colorectal cancer or melanoma at Miami Cancer Institute from May of 2018 through January of 2022. This covered the initial outbreak as well as the Delta and Omicron waves.

It revealed a significant jump in stage T2 cases of breast cancer and an increase in stage T4 diagnoses for colorectal cancer. In the 12-month post-pandemic timeframe, melanoma clinical stage T1 increased and colorectal cancer clinical stage N2 increased.

The staging system is based largely on tumor size and spread. T stands for primary tumor. The higher the number after the T (from 0 to 4), the larger the size of the tumor or the more it has grown into nearby tissues. Similarly, a larger number after N, which stands for lymph nodes, means more lymph nodes containing cancer have been found.

Joining Dr. Young in the research was a team of Institute informatics experts and statisticians. In addition, the study was a collaboration with Florida International University’s Herbert Wertheim College of Medicine, where Dr. Young is vice chair of the Department of Surgery. Baptist Health and FIU announced last spring the formation of a comprehensive alliance that will enhance the university’s medical school, provide training for new physicians and other health professionals, and expand clinical research. The first author of the study, Danielle Hanuschak, will graduate from the medical school in 2024.

Dr. Young is hopeful that the findings will help spur other long-term studies and bring about changes to avoid similar problems in the future. “It reinforces the importance of screening and early detection,” he says. “And it shows that when access to care is limited, whether it be because of a global health crisis, a pandemic or a war in a region, there might not just be an immediate window of repercussion, there might be long-term repercussions.”

One of the takeaways from the study, says Dr. Young, is that additional screening methods must be developed and expedited. Blood tests and cheek swabs to detect cancer are in the works, for example, and tests such as Cologuard for at-home colon cancer detection could be particularly useful in these situations. “There is an opportunity here,” he says. “This encourages us to think about how we could develop less-invasive screening.”

The ability to pivot quickly to telehealth, particularly in areas such as dermatology, may have helped keep the numbers of advanced melanoma cases down, Dr. Young says. “We saw just a slight increase in melanoma. We aren’t sure why. It could be because dermatologists could take a look at moles or suspicious lesions using telehealth. It could be that our population in Florida is more aware and better about the need for sun protection. It likely is multifactorial.”

The study results also point to the need for multi-institutional research that will better define what has happened around the country and the world. “This is convincing data from a single institution study, but it will be more helpful for the scientific community to do more thorough and collaborative studies using national databases and multiple sites.” Miami Cancer Institute is participating in a new study with other large cancer centers in the U.S.

If patients haven’t already asked their doctors about resuming cancer screenings, Dr. Young suggests they do so immediately to make sure they are on track. “Early detection is so important. Early-stage cancer is less likely to spread. As it advances, treatment options may be more limited and the likelihood of it being untreatable is greater.”