Has COVID-19 lost us the war on cancer?

Has COVID-19 lost us the war on cancer?

For several months in the spring of 2020, clinics and hospitals across the United States temporarily suspended routine cancer screening during the early phase of the COVID outbreak. Patients we’d reminded by mail and phone not to forget their mammograms or colonoscopies or PAP smears were suddenly told to cancel them and sit tight.

Most places have now resumed routine cancer screening, but the pause understandably raised lots of questions:

  • “Did the delay put me in danger?”
  • “Will there be a spike in advanced cancer cases now?”
  • “If this was so important, why was it delayed in the first place?”

A recent article in the Milwaukee Journal Sentinel suggested the delay might have cost us the chance to cure people. But there’s reason to doubt this.

Cancer screening depends on—and only works for—cancers that grow and spread slowly in the early stages. The most common types of breast, colon, lung, and cervical cancer take a few years to become dangerous. This long lead time is the very reason screening is possible. It’s also why it’s hard to see how a 3-6 month screening delay could be enough to allow a significant number of early-stage cancers to become incurable.

Right now you’re probably asking, “don’t some cancers appear more quickly and spread more aggressively than the usual type?”

Yes, there’s an exceptional minority of cancers that can appear and spread rapidly, sometimes within a few months. But screening doesn’t work for these aggressive cancer sub-types, and it never has. Cancer screening was never designed with this tragic minority in mind, since we have so little power to alter their clinical course.

I’m not worried about the brief interruptions in cancer screening we experienced earlier this year, since services have mostly resumed and we’re able to get back on track. I’m more worried that many of us will conclude cancer screening couldn’t have been important in the first place, if we can safely pause it—and that patients won’t reschedule. I fear that public skepticism and reactive rhetoric might interfere with cancer screening long enough to matter.

If we lose the war on cancer over this, it’ll be because we surrendered what cancer screening had already won for us.

COVID Testing in Brown County: Why You Should Bother

COVID Testing in Brown County: Why You Should Bother

The Wisconsin Department of Health Services has recommended COVID testing for all persons who live and work in Brown County.

The testing centers have a pretty convenient registration and drive-through process, but it’s still about a half hour of your life spent waiting.

“But I feel fine, and I’ve barely been out of my house! I don’t need a test!” you might be saying. And you’re right…you personally don’t need one, just like you personally don’t need census data.

But it’s still important to do it.

Asymptomatic testing ain’t about you. The data isn’t for you. It’s for the health departments and the epidemiologists who are still trying to get a better estimate of what the virus has done, is doing, and can do.

After everything COVID has already cost us all – the fear, the disruptions, the jobs, the isolation and boredom, and the growing mistrust in our public servants – another ask for the greater good seems like a lot.

But think back to all those numbers you heard early in the pandemic about transmissibility, the high number of asymptomatic carriers, and the estimated death rate…all those numbers you used to decide how scared (or not) to be, and how seriously (or not) to take the isolation recommendations. Those figures didn’t come from nowhere. They came from countries that were already grappling with COVID-19 and had some clumps of data to work with.

Yes, some of the numbers we’ve heard haven’t always been very accurate. But the only way they get more accurate is with better measurement, and that means a lot more data points…like yours.

Better numbers will hopefully help us make smarter decisions about when we can go back to something like normal life, and what we do (and don’t) need to do when COVID breaks out again. Maybe it’ll be less than we’ve done, maybe it’ll be more.

But wouldn’t it be better not to have to guess?

FAQ – Testing in Brown County

No Illusions

No Illusions

Though I’m an oncologist and not an infectious disease expert I’m getting bombarded with questions about the pandemic. Patients and staff are asking me and every one of my partners similar things, over and over:

How long until things go back to normal?

How much danger am I in?

Is it all going to be ok?

Though I’m supposed to have all the answers, I haven’t felt too sure of anything lately. It must show on my face, because recently one of my patients (a young woman living with incurable breast cancer) asked “how you doing there, doc?”

“Honestly, I’m not sure,” I said. “My regular routine is wrecked, I don’t feel as safe as I used to, and I don’t know what’s coming.”

“Welcome to my world,” she said, with a wry smile.

I suppose like everyone else in my privileged corner of the planet, where war is remote and epidemics are rare, I’ve been fooled into believing that the world is a safe place, that nature wants the best for us, and that we have control.

Somehow I’ve mistaken privilege for entitlement.

But the pandemic has stripped those illusions from me, just as cancer stripped them from my patient long ago. I’ve had to accept that there’s no such thing as safe – only safer. I’ve had to admit that I don’t have as much control as I’d like. And I’ve had to consider the very real possibility that I or someone I love might not survive.

And even if we and all our loved ones come through safely, somehow I doubt we can ever go back to the sleepy (and false) security of before. We may well divide our lives into distinct sections: “Before COVID” and “After COVID”, just as many patients have distinct lives before and after cancer.

And maybe we’re better off living without illusions of safety.

If life becomes more precarious, maybe it’ll also be more precious. Maybe in facing the truth of our mortality we’ll learn a deeper compassion for all survivors, everywhere – since every human breathing is a survivor of something. And if I’m spared, perhaps the me that comes after will have learned to live with more dignity and courage.

Maybe my patient will teach me.

COVID-19 and Cancer

COVID-19 and Cancer

Is this hype or is this real?

The death rate is about 1-3% – not as high as SARS, but about ten times higher than regular influenza.

But because COVID-19 is a new mutation, and humans have no innate immunity, the total number of cases may be extreme – so it could be 1-3% of a very, very large number.

It’s not hype.

It’s real.

How will my cancer treatment be affected?

If you’re currently receiving chemotherapy or radiation for your cancer, your treatments will continue without interruption.

If you’re newly diagnosed, consultations can still be scheduled in person or via a telehealth visit, depending on the nature of your specific problem.

Though non-urgent treatments and follow-up visits were previously on hiatus, as of early May 2020 we’ve resumed scheduling these visits. Depending on the nature of your problem, you may be offered the option of a telehealth visit instead of an in-person clinic visit.

As always, if you’re worried about recurrence or have a problem related to your cancer or its treatment that requires evaluation, we’re able to schedule a clinic visit for you.

Am I at high-risk to get sick from COVID-19?

Although even healthy people can become dangerously ill from COVID-19, the following types of patients are at especially high risk:

  • Patients currently receiving radiation therapy and/or chemotherapy (excluding CML patients taking oral medications)
  • Patients on chronic immunosuppression (such as steroids, anti-rejection medications, or medications for autoimmune diseases such as rheumatoid arthritis, lupus, or Crohn’s)
  • Patients who’ve ever received chemotherapy for leukemia or lymphoma (excluding CML patients who’ve taken oral medication)
  • Patients who’ve ever undergone a bone marrow or stem cell transplant
  • Patients with advanced stage CLL (> Rai stage 0)
  • Patients with untreated, advanced stage lymphoma (> stage 1)
  • Patients with any type of metastatic, non-hematologic cancer
  • Patients in remission from cancer, but who have significant heart disease, lung disease, kidney disease, liver disease, or diabetes

If any of these apply, it is even MORE important to strictly adhere to social distancing guidelines from the CDC and state health agencies – and avoid leaving home if at all possible.

Should I be wearing a mask?

REVISED: 4/3/2020

The CDC now recommends that all Americans wear a non-medical grade mask when leaving their homes.

It’s important to use a densely-woven fabric, because loose-weave fabric (such as T-shirt material) doesn’t keep you from spreading droplets.

Here’s a basic tutorial for sewing one:  

Keep in mind that the mask isn’t to protect you; it’s to protect other people FROM you. Like many thousands of others, you could have an asymptomatic COVID-19 infection – but yet still transmit it to someone else for whom it could be lethal. A properly-made cloth mask can reduce the likelihood that you’ll unintentionally harm someone else.

But masks don’t prevent airborne virus-containing particles from entering through your eyes. 

Masks don’t provide as much protection as good hand-washing, and following the social distancing and isolation recommendations from the CDC.

And you MUST NOT take these new CDC recommendations as an excuse to obtain or use a hospital-grade N95 mask for yourself, and further deplete the limited supply available for those on the front lines.

You have the freedom to keep a safe three-to-six foot distance from others, but healthcare workers don’t. Social distancing remains the most important thing the public can do to keep safe, and healthcare workers still need the N95 masks more than you do.

Use a cloth mask when you go out, not an N95. 

Are there effective treatments for COVID-19?

Because treatment options are so limited, the FDA is approving the use of drugs to treat COVID-19 based on very preliminary evidence.

Though this is an appropriate adaptation to our current circumstances, it may cause some treatments to appear – and then quickly disappear – as further study shows a lack of benefit (as happened with hydroxychloroquine).

At present, only the antiviral drug remdesivir has sufficient evidence to support its use, and it’s currently available for seriously ill COVID-19 patients.

There are presently no known drugs that prevent the illness. And though there’ve been some promising steps forward, a vaccine is still a long way off.