Covid consequences to linger with thousands skipping critical health screening appointments

Health experts fear rising deaths as the pandemic leads to delayed diagnoses of serious illness.

Data released from the Australian Institute of Health and Welfare shows that there were about 145,000 fewer mammograms performed through BreastScreen Australia from January to June, compared with the previous corresponding period.

Health experts fear the consequences of COVID-19 will linger long after the pandemic passes, with the virus spooking tens of thousands of Australians into cancelling essential appointments and check-ups for serious illness.

Diagnostic and pathology services are still trying to catch up on missed appointments — more than six months after the pandemic forced the shutdown of screening services. Health experts are now concerned that early and treatable cancer diagnoses have been skipped, potentially leading to preventable deaths and greater costs on the health system.

Data released from the Australian Institute of Health and Welfare shows that there were about 145,000 fewer mammograms performed through BreastScreen Australia from January to June, compared with the previous corresponding period.

In the three months to September the backlog started to clear, with about 12,000 more mammograms performed compared with the same time in 2019.

Forecasts on the toll of the delayed screenings vary. Researchers at the University of Melbourne, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and Walter and Eliza Hall Institute have “conservatively estimated” a three-month delay will lead to 90 additional deaths and cost the health system an extra $12m in the next five years.

Carmel Monaghan, the chief executive of Ramsay Healthcare’s Australian operations, told The Weekend Australian it was “too early to measure the long-term effects of delayed cancer screening” but warned of the potential health consequences.

“During COVID-19 restrictions we did see some changes in people’s behaviour in relation to deference of cancer screening, and therefore as we come out of these restrictions there is a risk that we will see later stage cancer progression,” she said.

Early detection

“Cancer screening and surveillance programs are vital to ensure that we detect cancers early. By detecting cancers early there are more treatment options and improved survival prospects.”

Ms Monaghan said many people were concerned that visiting a hospital for a cancer screening would put other patients or themselves at risk of catching COVID-19. But unlike other countries, she said Australian hospitals had shown they are safe, thanks to strict protocols and social distancing measures.

“In Australia we diagnose 150,000 cancers each year and there are 50,000 cancer-related deaths. In comparison we have had 900 coronavirus deaths in Australia,” she said.

“Hospitals and healthcare facilities have been shown to be remarkably safe in relation to COVID-19 and so people should not avoid cancer screening.”

Victoria Atkinson, chief medical officer at Australia’s second-biggest private hospital group Healthscope, said COVID-19 restrictions had sparked confusion among many patients, particularly when non-essential surgery was cancelled during March and April.

“Many patients and healthcare providers were unsure of what ‘essential medical care’ was,” Dr Atkinson said.

“People with chronic disease such as heart disease, cancer, mental illness and diabetes have been unable or unwilling to access the essential surveillance that allows them to manage their condition and to function well within the community. For example, cancer survivors unable to access colonoscopy to look for recurrence, or a diabetic patient who has not been able to have their eyes checked and could be risking blindness.”

Dr Atkinson said self-diagnosis had potentially devastating consequences.

“A colleague told me of a man who had respiratory symptoms earlier this year in Victoria. He duly attended his local hospital for a COVID-19 test and when the test was negative, he chose not to attend a specialist for further investigation despite his cough and breathing becoming worse.

“He is now being treated for advanced lung cancer. The latter half of 2020 has seen people present with delayed diagnoses and so more complex treatments and poorer outcomes.

“Conversations must shift from COVID-dominated to COVID-contextualised. People need to clearly prioritise all their healthcare needs and trust that the system is safe and welcoming to them. The reality is, if we don’t actively re-engage Australians with their healthcare system now, the legacy of 2020 will stay with us long after the virus fades into history.”

Backlog

The delay of cancer screenings has created a significant backlog in the world’s biggest economy, the US, where COVID-19 has killed more than 2600 people a day in the past week.

Breast screening programs were shut down during March and April in the US, delaying about 6.7 million out of the 40 million mammograms that are performed in the US each year.

ASX-listed Volpara Health Technologies, which specialises in breast cancer detection software, is helping clear the backlog to help save the lives of women and their families.

Volpara chief executive Ralph Highnam told The Weekend Australian that the company’s software was helping detect those most at risk and arrange urgent scans.

“In March and April breast cancer screening around the world stopped. Certainly in America, where the pandemic is still raging, screening levels are now where they were before COVID-19 but they are doing a lot of catch-up work,” Dr Highnam said.

“Our software does many things for a breast cancer screening clinic. The stuff most related to the pandemic includes that instead of having a chief technologist go around to all the sites to make sure they are working properly, they can log in remotely in one central location and actually see how all their machines are working.

“And there are some sites in the US using our software to assess the risk of developing cancer. They can see that ‘this woman missed screening and they’re high risk, so we are going to get them back in first’. So there is lots of work around prioritisation to do that catch-up.”

Volpara also signed a five-year contract to deploy its software across BreastScreen Queensland. The deal will initially involve launching VolparaEnterprise across 11 BreastScreen Queensland services in Brisbane and then elsewhere in the state.

“Public breast cancer screening programs around the world do a fantastic job at reducing deaths from breast cancer, and they do so by operating under the strictest quality control, which can make change difficult,” Dr Highnam said.

“But, we are delighted to now have BreastScreen Queensland signing up to use our software, making it the second major public breast cancer screening program in Australia signed up to Volpara products.

“This is news that will resonate around the world, and we are extremely pleased that our software will be helping women in the fight against breast cancer, including women in the lives of many of our long-term investors.”