COVID-related Delays in Colorectal Cancer Screening Jeopardizes Preventive Care, Early Treatment

With the COVID-19 pandemic interrupting non-urgent medical care, physicians are concerned that important gains in preventing colorectal cancer could be lost and their patients could miss out on life-saving preventive care or treatment.

Colorectal cancer is the second-leading cause of cancer death, yet it is highly preventable and treatable with screening and early diagnosis, said Laura J. Zimmermann, MD, MS, medical director of Rush’s Prevention Center and assistant professor of Preventive Medicine and Internal Medicine at Rush Medical College.

“If it’s caught early, it has a really high cure rate, but if by delaying we find something later, it may be harder to treat,” she said.

Colonoscopies to screen for colorectal cancer came to a stand-still for more than two months when most states halted elective surgical and endoscopic procedures to help hospitals address the surge in COVID-19 cases. In Illinois, the stoppage lasted from mid-March through mid-May. Before the pandemic, Rush was performing about 800 colonoscopies a month on average.

While Rush is starting to perform screening colonoscopies again, colorectal surgeon Dana Hayden, MD, MPH, associate professor and chief of the Division of Colon and Rectal Surgery at Rush Medical College, worries that the delay in care will linger and patients who had taken the important step of scheduling a colonoscopy may put off rescheduling and others who are due to be screened won’t.

“We really don’t know how long the delay could last,” Hayden said. “Patients may be focused on more urgent matters than preventative care and may also be nervous about coming to the hospital while the pandemic continues.”

That would reverse a positive, lifesaving trend: 

The rate of people over age 50 who are up to date on colorectal cancer screening has improved greatly in the past several years, from 38% in 2000 to 66% in 2018, according to the American Cancer Society.

“As the rate of screening has increased in these age groups (over 55 years old), the incidence of colorectal cancer has decreased,” Hayden said. And the mortality rate has declined as well.

Delayed screening means people will miss the opportunity to prevent or treat the disease early. That leads to a greater incidence of cancer, which is diagnosed at later stages with more severe symptoms and higher mortality, she said.

While it is impossible to know how much screening will be missed because of the pandemic, a look at the number of new colorectal cancer cases projected for 2020 in the U.S., two months with little or no screening theoretically could postpone diagnosis of cancer in 24,650 patients, among those some 9,860 cancers that may be at an advanced stage already.

Unlike some other cancers, screening for colorectal cancer can do more than find cancer; it can help prevent it. A colonoscopy identifies cancer in its earliest most treatable stage and finds pre-cancerous polyps that the physician can remove during the procedure, preventing progression to cancer.

People who cannot have or are reluctant to have a colonoscopy and who are not especially high-risk may be able to take other tests, she said. The stool-based fecal immunochemical test (FIT) looks for hidden blood in the stool and a stool-based DNA test can find precancerous and cancerous DNA within a stool sample; both tests can identify markers of large colon polyps and cancer.

Even with the higher rate of colorectal screening, a third of Americans over 50 have not been tested. These home-based tests in which samples are sent to a lab have been embraced by patients who otherwise may not be screened at all.

“A colonoscopy is the best way to prevent cancer, but it may be better to have more people undergo a good test than fewer people having the best test,” Hayden said.

A primary care provider will help a patient choose the test they need during an office visit or a telemedicine (phone or video) visit, Zimmermann said.

“The discussion is very much based on health history. I don’t need to examine them physically to know if they are of average risk,” she said.  Telemedicine allowed her to continue ordering colonoscopies and home-based tests for her patients during Illinois’ stay-at-home pandemic restrictions.

Some patients will need a colonoscopy rather than a stool or blood test, such as if they have a family history, a condition that increases the risk of colorectal cancer or if they are having symptoms such as rectal bleeding. 

For anyone who is due or overdue for a colorectal cancer screening this year or has been delayed by the pandemic, this is the time to schedule a colonoscopy or an appointment to discuss screening options.

Rush University System for Health is performing colonoscopies and offering other gastroenterological and colorectal surgery services with expanded evening and Saturday appointments at more locations: River North, South Loop, Oak Park and Oak Brook in addition to Rush University Medical Center. 

Rush also has adopted extensive safety measures to protect patients from COVID-19 across all its facilities, such as restructuring offices to allow for social distancing, providing hospital-grade masks to all patients, visitors and staff and checking all for fever (temperature of 100 degrees or higher) at our entrances. Before their appointments, patients are asked about any symptoms that could indicate they are infected with the novel coronavirus.

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