Delayed due to COVID-19, cancer screenings slow to resume

Thousands of routine cancer screenings in Waterloo region and Wellington County were delayed during the early months of the pandemic and it isn't clear yet how long it will take the healthcare system to catch up.

In March of this year, the province temporarily paused a number of non-essential healthcare services to control the spread of COVID-19.

According to local data provided by Cancer Care Ontario, which is now a part of Ontario Health, between March 15 and May 31 this year there was: 

• A 98 per cent decrease in mammograms, which screen for breast cancer.
• An 88 per cent decrease in Pap tests, which screen for cervical cancer.
• A 72 per cent decrease in fecal immunochemical tests (FITs), which screen for colon cancer.

The numbers in Waterloo-Wellington closely mirror trends seen across the province. This spring, there was a 97 per cent dip in mammograms, an 88 per cent decrease in Pap tests and a 73 per cent decrease in FITs province-wide.

The dip in screenings is concerning to Dr. Ahmad Firas Khalid, a doctor and health policy expert at Wilfrid Laurier University.

"When we delay screening, we do jeopardize our ability to diagnose those things very early on," said Khalid.

Screenings resume

At the end of May, healthcare providers were given the green light to gradually resume services.

Since then, cancer screenings have started up again and the system is working to get back on track as safely as possible, said Dr. Linda Rabeneck, vice-president of prevention and cancer control at Cancer Care Ontario.

Still, the most recent available data shows screenings haven't yet caught up to pre-pandemic levels. How quickly the system catches up will depend on what happens with the pandemic going forward, said Rabeneck.

"The more intense the pandemic … the more challenging it will be for us to resume fully, promptly, cancer screening services," said Rabeneck.

When looking at the number of screenings done in Waterloo-Wellington this year compared to 2019 Cancer Care Ontario says that in July: 

• 41 per cent of expected mammograms were performed.
• 54 per cent of expected Pap tests were performed. 
• 21 per cent of expected FITs were performed.

Again, provincial numbers show similar trends. In July of this year, 45 per cent of expected mammograms were performed, 35 per cent of expected Pap tests were performed and 17 per cent of FITs were performed province-wide compared to July 2019, according to Cancer Care Ontario. 

In a statement, Cancer Care Ontario noted that the low number of FITs are due to the fact that LifeLabs only resumed mailing the testing kits to patients on July 6.

Rabeneck explained that screening for cancer is a process that involves many moving parts, including primary care offices, hospitals, imaging facilities and outpatient clinics.

"To the extent that those elements of the health system are tied up with issues related to the viral pandemic, then we won't be able to resume cancer screening as promptly as we want to," she said.

'It's so important'

Rachel Bartholomew said the numbers are troubling on a personal level. Bartholomew has been through cervical cancer treatment herself, and in her case, she didn't receive a diagnosis until cancer had already developed.

She counts herself lucky the cancer was caught before spreading to her lymphatic system.

"With every passing moment, those situations get worse and worse," said Bartholomew.

Bartholomew now urges everyone she knows to get regular screenings and to speak to their doctor if they notice any worrying symptoms.

"I can't rant and rave enough about that," said Bartholomew, who lives in Wellington County. "I know I pushed all my girlfriends and friends to go get Pap tests, and the majority of them did after I got diagnosed.

"It's so important."  

Rabeneck said it isn't clear how long screenings can safely be delayed before there is an effect on people's health. Going forward, she said Cancer Care Ontario will monitor how many cases of cancer are diagnosed and at what stage, to get a sense of the impact. 

What to do if you're due

Rabeneck emphasized that screenings have now resumed in all parts of the province and that people should not avoid getting screened.

Anyone who knows they're due, she said, should speak to their doctor or primary care provider about how to proceed.

 "We're encouraging people in the target age groups to talk to their family physician about screening," said Rabeneck.  

Those who don't have a family doctor could speak to a care provider at a walk-in clinic, or call TeleHealth for further guidance, she said.

Cancer Care Ontario has not yet restarted its correspondence program, which sends reminder letters to people who are due for screening, but plans to do so soon, she said. 

Going forward

Khalid said he understands why the healthcare system put a temporary hold on certain services this year to control the spread of COVID-19. But, he said it's crucial now to quickly build up capacity in the healthcare system so that a similar situation doesn't repeat itself.  

"Screening programs should never be put on hold, regardless of what the crisis is," he said.

CBC News asked the Ministry of Health what it is doing to ensure cancer screenings continue as COVID-19 cases rise, and whether there is any chance screenings could be halted again.

In a statement, a spokesperson said the province is spending up to $283.7 million to support priority surgeries and to extend diagnostic imaging hours at health care facilities that provide MRIs, CT scans and cancer screenings.  

The spokesperson said the ministry is also increasing capacity in home and community care and expanding digital and virtual health care services.