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By Jacqueline Lisk
This article is a part of Studio/B’s Breast Cancer Explored series, exploring the state of breast cancer in 2020 through stories from survivors, loved ones, doctors, and researchers.
Christine George almost canceled her routine mammogram because of the coronavirus.
“Thank God I didn’t,” she says. “I wonder if I had canceled, in a year or two from now how much more advanced would my cancer be, and what would my treatment look like?”
George and her doctor found her breast cancer early. Her tumor is small and slow-growing, and her cancer has not metastasized. George knows the importance of early diagnosis because she served on the Susan G. Komen Massachusetts Board for eight years.
“I have met a lot of survivors and heard their stories,” George says. “But never did I ever believe that I would be the one in the seat of so many of the women that I’ve met.”
The earlier you detect your breast cancer, the better your prognosis. But some people are hesitant to visit medical facilities during the COVID-19 pandemic or are experiencing delays in their care due to the virus. According to data from two surveys by the American Cancer Society Cancer Action Network, one in early April and one in May, 27% of cancer patients and survivors report delays in care, and 19% are unsure when their appointment will be rescheduled.
National Cancer Institute (NCI) director Dr. Norman Sharpless warns there could be nearly 10,000 excess deaths in the U.S. over the next 10 years from breast and colorectal cancer because of COVID-19-related delays, according to NCI data modeling. That figure doesn’t account for people who will need more invasive treatment because their cancer wasn’t caught early, like George’s.
Reopening amid COVID fears
Dr. Beverly Moy, clinical director of breast oncology and director of cancer equity at Massachusetts General Hospital, notes that clinics and hospitals had to shut down routine screenings during the height of the COVID-19 crisis to keep patients and staff safe and allocate resources to the pandemic.
“Now we’ve opened back up and are encouraging patients to get their mammograms. But we’re concerned fear about COVID-19 may be preventing patients from returning for their screenings,” Moy explains. “We’re worried about the potential for later stage diagnosis as a result of missed or delayed appointments.”
When Moy sees new patients at her practice, the disease is often more advanced than what was typical pre-COVID. Some patients even told her that they noticed something abnormal but put off seeking treatment because of COVID-19.
What preventive visits look like now
Moy wants patients to know it is safe to come back. Boston-area medical facilities have taken precautions to minimize the risks of contracting COVID-19, including new cleaning protocols, curbside registration, requiring masks, supplying personal protective equipment for staff, mandating social distancing, rolling out new hours, and limiting visitors and guests.
Dr. Rachel Freedman, medical oncologist and medical director at Dana-Farber Cancer Institute (DFCI) Cancer Care Collaborative, notes most patients now feel “safer in their medical environment than they do at the grocery store.”
Safety measures are vital, but they can present their own challenges too. Many facilities no longer allow guests to accompany patients to all appointments. It can be frightening to face these visits alone and hard to listen when your mind is racing. Freedman says many patients are video conferencing their loved ones from the exam room so they can support them virtually.
Going to appointments alone is particularly stressful for patients who don’t speak English. Codman Square Health Center in Boston relies on bilingual staff and translators for help communicating with their diverse patient population, says Eileen Boyle, chief technologist and manager of radiology at the center. And they will let a patient bring a guest if absolutely needed.
Boyle says her patients were anxious when the facility had to temporarily close routine screenings due to COVID-19 and relieved to hear when it was open again. “I think they needed some normalcy and stability in their healthcare,” she says.
In July 2018, the American Cancer Society and the New England Patriots Foundation awarded Codman Square Health Center a $100,000 grant so it can provide access to breast cancer screening and follow-up care. They recently extended the grant through December to help make up for the decrease in screenings in prior months.
Window of opportunity
Erica Warner, epidemiologist and project director at Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, surveyed women around the country about their experience receiving breast cancer care during the pandemic. She found the most frequently delayed visit was a mammography or screening.
A small delay is unlikely to have a significant impact on someone’s breast cancer prognosis, says Warner. But delays of six months or longer are worrisome.
She notes the odds of getting COVID-19 in the Boston area are low right now. “Use this as a window of opportunity to get out there and see your doctor,” Warner says.
If you are at high-risk for severe illness from COVID-19, talk to your doctor and decide the best way forward together.
Whatever you do, don’t put off your health. George is glad she didn’t.
“Because it was caught early, I was able to avoid a mastectomy and chemotherapy,” George says. “ For that I am grateful.”
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