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Despite delay in screenings, no rise in breast, colon or cervical cancer … for now

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While some delayed exams in the height of the COVID-19 pandemic, an Epic Research study finds no increase in cancer cases. Christopher Alban of Epic talks about the study, and the need for more investigation.

Christopher Alban admits he was worried about what he might find.

A clinical informaticist at Epic Systems Corp., Alban and other Epic researchers examined the rates of breast cancer, cervical cancer and colon cancer during the COVID-19 pandemic. With screenings temporarily dropping during the pandemic, researchers feared there would be an increase in cancer diagnoses.

However, researchers found that there has not been an uptick in those three cancers, which they say is encouraging. But it doesn’t rule out the possibility of increases down the road, Alban told Chief Healthcare Executive® in a recent interview.

After the study, Alban describes a sense of “qualified optimism.”

“We're only looking at three diagnoses, sort of the common ones, ones that we, number one, we screen for, we do that approach, and that are common enough to be significant issues,” he says.

“And so the time window was short, and that's the reality here is we're back to screening. We picked up the diagnoses we expected, and what the impact long term might be, we haven't hit long term yet. So we don't know. We need to keep watching, for sure.”

Researchers also say they didn’t find an increase in the severity of cancers.

While Alban says that is promising, he also cautions against drawing any last conclusions.

“It's too short a window,” he says. “Again, optimistic, hopeful, and it's good not to find that. At these numbers, that's, that's solid. But you don't go throwing a parade yet. We've got to keep monitoring, and watching.”

He doesn’t discount the possibility that additional research, in time, could uncover an uptick in more advanced cancers.

“You’ve got to look at the numbers and look, monitor over time to see what's going on,” he says.

(See part of our conversation with Christopher Alban of Epic. The story continues below.)

‘Keep an eye on this’

Going forward, Alban says, “We need to keep an eye on this because there may be more people who fell through the cracks that we need to be ready to catch.”

Epic researchers examined 373,574 cancer diagnoses in patient charts between Jan. 1, 2018 through Dec. 31, 2022. They also looked at data from Jan. 1, 2018 through Dec. 31, 2019 - a baseline before the arrival of COVID-19 - and compared weekly diagnosis rates.

While there was a drop in screenings and cancer rates early in the pandemic, cancer exams rose, along with typical cancer rates, the researchers said. From 2020-2022, there was not a significant jump in cancer diagnoses, according to the study.

Health systems and previous studies found, understandably, a decline in cancer screenings earlier in the COVID-19 pandemic. In the first months after the arrival of COVID-19, some hospitals scaled back non-emergency procedures and other services.

A study which examined hundreds of cancer programs between April and June 2021 found a 55% drop in breast cancer screenings, an 80% drop in colon cancer screenings and a 69% decline in screenings for cervical cancer; the findings were published in Cancer in March 2022.

In October, some health systems told Chief Healthcare Executive that breast cancer screenings have rebounded, but they remain below pre-pandemic levels.

Nationwide, screenings appear to have returned to typical levels, Alban says, but it’s certainly plausible that some areas are still seeing a lag in cancer exams.

Consider outreach

Health systems and hospitals should be looking at their own health records to see if there are increases in certain cancer diagnoses, Alban says. Some hospitals say they have seen sicker patients, who have required longer stays, due to deferred care in the pandemic, the American Hospital Association said in a report last August.

He also says systems should also be reviewing their numbers on cancer screenings to see if some patients have fallen behind.

“For any individual healthcare organization, you want to be looking internally at your own numbers, your own processes,” he says. “And understanding, where are we doing well, where are we not, where do we need to focus attention to ensure our patients get in? Do we need to do a campaign? Do we need to do outreach?”

Some health systems may also need to employ new methods of outreach if they are seeing a drop in screenings, among underserved populations.

“Recognize that they're not all the same,” Alban says. “We have equity issues, we have access challenges. How do we think about those and putting programs in place, engagement processes to connect with them, and meet them on their own terms?”

With more than 25 years as an informaticist, Alban says he’s heartened to be able to use the data from electronic health records and produce such broad studies in a relatively short amount of time.

“This is one of the holy grails of doing electronic medical records,” he says.

“Having some of that data in a standardized way that can be aggregated in safe and protected ways to be able to look at these sort of descriptive statistics … and understand what's actually happening at a large scale.”

To be able to take data and turn it around in weeks “is crazy,” he says. “And that’s crazy good. That’s the reward of this.”

“Now, it's different than doing a randomized control trial,” he adds. “We're looking at descriptive statistics. So there's limits to what you can do here. But still, there's a lot you can do here.”

Health systems can take that data and now use it as a tool to examine their own communities, and to see if some groups are being missed or need more attention.

“Take a look at your own stuff, look at where your concerns might be, and make sure you reach out effectively to your patient populations,” Alban says.


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