Cancer screening is the most important part of early diagnosis. However, the Covid-19 Pandemic, which came into our lives in 2019, negatively affected the regular cancer screening like many other things. People started delaying health scans due to fear of viruses.
From Yeni Yüzyıl University Gaziosmanpaşa Hospital Oncology Department, Assoc. Dr. Hamza Uğur Bozbey gave information about the ‘decreasing cancer screenings during the pandemic process’ Exp. Dr. Hamza Uğur Bozbey underlined that cancer screening rates have decreased by 80% in our country and stated that the rate of discontinuing treatment doubled. Cancer screenings provide early diagnosis in cancer.
Detection of cancer in the early period thanks to screenings naturally affects the treatments (chemotherapy, radiotherapy, surgical intervention), treatment times, the patient’s quality of life and life expectancy. However, the situation is different when caught at an advanced stage (metastatic). If a patient is diagnosed with colon cancer at stage 1, the patient has a 90% chance of survival. However, when the same patient is not diagnosed until the 4th stage, the 5-year survival rate drops to 11%. Therefore, the stage at the time of diagnosis is really important.
The COVID 19 pandemic, which has been seen all over the world and in our country since 2019, should not prevent cancer screening. Cancer screening, which is recommended according to the age and risk content of the individuals, should not be disrupted. Although telehealth seems to work to some extent, mammography, colonoscopies, laboratory tests and physical examinations used for early diagnosis, especially in cancer screening, should be completed. For this reason, we recommend that patients apply to hospitals in order to receive healthcare services. It is important that hospitals and other health centers are organized in accordance with Covid-19 procedures for the safe use of the physical area where the examinations are performed.
A study conducted in the USA showed that there was a great decrease in cancer screening tests and biopsy procedures in hospitals during the 7-week pandemic period between January and February 2020. In the study conducted with nearly 300,000 patients, the new diagnosis breast, colorectal (large intestine), lung, pancreas, stomach and esophagus (esophagus) cancer ICD-10 codes were scanned weekly between January 1, 2018 and April 18, 2020. Average weekly diagnosis numbers for each cancer were determined.
They then compared these numbers with the weekly average number during the first 7 weeks of the pandemic. 7.2% of the patients enrolled in the study were in the Covid-19 pandemic period. For all 6 cancers, the number of weekly diagnoses decreased by nearly 50% during the pandemic period compared to the baseline period. The greatest reduction in follow-up registration or diagnosis was seen in breast cancer cases with 51.8%.
The situation was similar in other countries outside of America. During the Covid-19 restriction period, a 40% decrease in the weekly frequency in the Netherlands and a 75% decrease in the UK was observed in follow-up suspected cancer.
The situation was similar in our country. Cancer screening rate has decreased by nearly 80%. The rate of withdrawal has doubled. The rate of referral of symptomatic patients to the hospital has decreased by almost 70%.
However, in the first months of the pandemic, medical organizations all over the world agreed to delay routine screenings for a while. It was thought that there would be no harm if the visits to be made in March-April were postponed for one or two months. In other words, it was assumed that delaying the colonoscopy recommended to be performed every 10 years for 3-4 months or the mammography recommended to be performed every 2 years would not be very important, but the examination of patients with complaints should not be delayed. It was unpredictable when the pandemic would end. Despite this, even symptomatic patients were delayed in diagnosis. Since it is not known when the pandemic will end, the medical community now agrees that examinations and scans are carried out on time.
COVID vaccination in cancer patients
Since there is no live virus vaccine like classical inactivated virus vaccine (SINOVAC), mRNA (BIONTECH) vaccines among the COVID vaccines used, it can be safely applied to cancer patients. Efficacy may be low, especially in patients receiving active chemotherapy. Considering that administering any of these vaccines will reduce the risk of COVID infection in cancer patients, it is recommended to have one of the COVID vaccines approved by the Ministry of Health.
During the pandemic period, if the patient needs to start chemotherapy without waiting, or if the patient is receiving chemotherapy, COVID-19 vaccines can be administered just before chemotherapy begins or between chemotherapy treatments. In this process, the ideal time for patients who are planned to be vaccinated is the days when the effect of cancer treatment on the maximum blood table (the lowest level of neutrophil values) is the farthest, so it is necessary to wait approximately 10 days or longer from chemotherapy at the earliest.
The possibility that the expected benefit from the vaccine will be low should not be ruled out when the vaccine is administered to the patient while receiving chemotherapy. The vaccine response may be very limited in patients receiving cortisone and / or anti-B cell antibody (Ex: Rituximab) treatment for more than 10 days at a dose of 20 mg / day or more, but considering the pandemic conditions, vaccination may still be is recommended. In stem cell transplant patients, the vaccine can be administered as soon as the blood picture of the patient improves after the transplant, but it should be kept in mind that the expected benefit from the vaccine may be low.
COVID-19 vaccine can be administered to patients who receive targeted drug therapies such as monoclonal antibodies or tyrosine kinase inhibitors. Since the most risky period for systemic side effects of COVID-19 vaccine is in the first 2-3 days after vaccination, it is believed that immunotherapy treatments should not be performed these days.