Fewer Alaskans were screened for cancer in 2020 than in pre-pandemic years

Fewer Alaskans showed up for their routine cancer screening in 2020 than in previous years, their doctors say.

It’s a trend that could be deadly if it persists, though it’s too early to measure the impact.

Most of the medical providers the Daily News spoke with for this story said the drop in screenings was likely linked to coronavirus-related anxiety that has lasted through the pandemic, as well as a temporary ban on elective medical procedures that the state enacted in March to preserve personal protective equipment and help keep COVID-19 cases down. That ban was lifted in April, but virus case surges in the summer and fall/winter have kept anxiety over COVID-19 exposure high.

In the meantime, some providers have made a shift to virtual medical care — which is helpful for some, but not all, types of cancer screenings.

The drop in screenings

Routine cancer screenings are important because they increase the likelihood of survival by speeding up a diagnosis.

“If we (screen) in specific intervals, there’s a very good chance that if a cancer is found, it’s going to be its early stages,” said Dr. Szilvia Salamon, a family physician with Providence Medical Group Primary Care. “That makes chances of successful treatment much higher.”

There are four types of cancer that the federal Centers for Disease Control and Prevention recommends asymptomatic testing for: cervical, breast, colon and lung cancer.

The agency recommends that most women under 65 get screened every three to five years for cervical cancer depending on their age and past test results. National recommendations for breast cancer screening vary, but typically encourage most women between the ages of 50 and 74 get an annual mammogram.

Screenings for colon cancer are recommended at varying frequencies for adults between the ages of 50 and 75, and annual screenings for lung cancer are recommended for higher-risk adults with a history of smoking who are 55 and older.

Salamon said her department at Providence tracked a 4% decrease in patients who were up-to-date on their colon and breast cancer screenings between November 2019 and November 2020.

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At the diagnostic imaging center at Juneau’s Bartlett Regional Hospital, there were exactly 330 fewer mammograms and 28 fewer lung cancer screenings last year than there were in 2019, according to Paul Hawkins, the director of the imaging center. The initial dip occurred in March and April and screenings have since started to pick back up, Hawkins said.

Not every provider has observed a drop in screenings. Ellen Ruby-Markie, who is the practice administrator at the Anchorage Women’s Clinic, said that the facility has seen few changes in demand or volume at all since the spring pause.

“For us, it’s really been consistent throughout the year,” she said.

The main form of preventive care the clinic offers is an annual “well woman” exam that includes a pap test— which checks for precancerous cells that can lead to cervical cancer in women — as well as a breast exam.

This annual visit to a obstetrician-gynecologist is important, and it was encouraging to see patient volume stay consistent over the past year, Ruby-Markie said.

Logistic challenges to medical care

Dr. Anusiyanthan Mariampillai, an oncologist at the Alaska Native Medical Center, thinks it is likely too early to know whether the overall drop in screenings will have a significant impact on cancer rates and deaths in the state.

“But we may in the next year or so see that change,” he said. One important factor will be how long patients put off the screenings, he said. Waiting a whole year can be much more detrimental than pausing for a couple weeks or months.

Oncologists typically see patients after they’ve already been screened for and diagnosed with cancer.

Since the pandemic began, Mariampillai said he has witnessed a higher percentage of patients who couldn’t come to their appointments. This trend is just as worrisome as missing screenings, he said.

“Anecdotally, from my personal experience, there have been more cases than normal where there’s a clinical change in the person’s status because of logistics related to the pandemic,” Mariampillai said. “For example, patients stuck at home in quarantine couldn’t come here because they were COVID positive, and that made them feel worse. Or missing appointments because they were in a household where they were in lockdown.”

Many of the patients seen at the Alaska Native Medical Center fly into Anchorage from remote villages across the state. Pandemic-related precautions and restrictions have complicated the logistics of traveling for treatment.

Throughout the pandemic, most communities in Alaska have had their own rules surrounding prevention and travel, and some have been stricter than others. For a patient who needs to come to Anchorage for treatments every three weeks but must quarantine for two weeks post-travel, accessing care is complicated, Mariampillai said.

Delays and logistical challenges to seeking care could help explain a slight increase in cancer deaths recorded by the state health department in 2020, Mariampillai said.

“I’m sure there (has) been an increase in cancer deaths due to lack of access to cancer care during the pandemic,” he said. “I think that’s pretty accurate.”

Virtual solutions

In the fall, when her team noticed that many patients were putting off their screenings, Salamon with Providence said she started to actively reach out to her patients to encourage them to come in for routine screenings like mammograms.

Some patients were worried about possible exposure to COVID-19 in medical settings. She explained to them that the benefits outweigh the risks, and that it is generally more harmful to postpone medical care than to risk COVID-19 exposure by coming in.

“The COVID exposure (in a doctor’s office) is less than having to go to a grocery store,” she told them.

Then for those patients who were older and at a higher risk for severe illness from the coronavirus, or reluctant to come in for other reasons, there were also new virtual options for care — including some cancer screenings, Salamon said.

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As an alternative to a colonoscopy — which requires an in-person procedure plus a follow-up observation period — she started prescribing an at-home stool test for some patients who qualified.

There’s also a free annual exam, a wellness visit, that is covered by Medicare and can be done by phone or videoconference.

“The virtual visits are working well for this because really, there’s often no reason for a patient who is otherwise well to come in person,” she said.

Mariampillai said the shifting emphasis on telemedicine was also relatively easy for the Alaska Native Medical Center, which often treats patients in remote parts of the state.

“Since we were already familiar with the telemedicine system, we were able to increase the number of telemedicine visits accordingly, and still take care of our patients,” he said. “It just required a little bit more creativity.”

Correction: A previous photo caption incorrectly stated that Dr. Salamon works with Providence Alaska Medical Center. She works with Providence Medical Group Primary Care, a separate organization under the Providence umbrella.