COVID-19 has shaken up the medical world, not only for health care personnel on the front lines of helping people who are infected by the virus, but also for those who care for patients with other medical conditions.
A team of researchers from the University of Michigan Department of Family Medicine have recently published a commentary in the journal Cancer, forecasting that at-home screenings may be the wave of the future when it comes to detecting some cancers, including colorectal and cervical cancers.
The move towards at-home cancer screenings provide excellent options for average-risk patients undergoing regular cancer screenings. Those with higher risk due to familial disease, genetic variants, or prior cancer precursors will need other in-office options, according to the researchers.
Commentary authors include Sherri N. Sheinfeld Gorin, Ph.D., FSBM; Masahito Jimbo, M.D., Ph.D., MPH; Robert Heizelman, M.D.; Kathryn M. Harmes, M.D., MHSA; and Diane M. Harper, M.D., MPH, MS, all from the Department of Family Medicine at the University of Michigan. Dr. Harper is also a member of the Department of Obstetrics and Gynecology, among other departments.
The commentary is titled, “The Future of Cancer Screening After COVID-19 May Be at Home” and is based on the authors’ study that described the patterns of cancer screening in response to the state-wide shelter-in-place executive order within a large, Midwestern private medical center.
The authors examined clinical data of 56,932 unique adult outpatients receiving breast, cervical and colon cancer screenings compiled between March 19 to May 9 and May 10 to June 7 from 2017 to 2019 -- dates that coincide with the first part of the coronavirus shut-down in 2020, to compare patient visits. Researchers also added an additional time period during COVID control to show screening rates as restrictions were being lifted.
The data showed in-office cancer screenings decreased “precipitously” during the time of the medical facility shut-down but that home screenings for colorectal cancer using Cologuard® diminished significantly less (by approximately 65 percent) than that for colonoscopy and breast and cervical cancer screenings conducted in the clinic. By comparison, national data showed that as of April 25, 2020, cervical cytology and breast cancer screenings dropped 94 percent each and all colorectal cancer screening dropped by 86 percent.
This could translate to approximately 36,000 missed or delayed diagnoses of breast cancer during the early part of March through early June. Missed diagnoses of cervical cancer are estimated at 2,500 cases and 18,800 cases for colorectal cancer, according to the IQIVA Institute for Human Data Science.
Drs. Sheinfeld Gorin and Harper cite the very high accuracy of several colon cancer tests, such as Cologuard® and FIT (Fecal Immunochemical Test) as a reason why individuals at normal risk of colon cancer could opt for at-home screenings. Dr. Harper characterizes colorectal cancer as “highly under-screened” and mentions that looking at DNA is a more reproducible way of detecting colon cancer since the naked eye does not have molecular discrimination and can miss trouble areas, such as flat polyps in the colon. Furthermore, there can be real and lethal risks associated with performing colonoscopies.
Another compelling reason to have at-home cancer screening tests is for underserved communities and those who do not have easy access to primary care physicians.
“There aren’t that many gastroenterologists (GIs) in urban underserved communities or in rural areas,” Dr. Sheinfeld Gorin said. “Access becomes a real problem if the colonoscopy is considered the best test for all and under all conditions.
“Home screenings provide much better access to people in rural communities. The best test is the one that you do. If you don’t do the test, it doesn’t matter what the gold standard is.”
The same access issue occurs with cervical cancer screenings. An at-home cervical cancer test is planned for clinical trials to gain FDA approval.
“Cervical cancer doesn’t lead to as many deaths as colorectal or breast cancer in the United States” Dr. Sheinfeld Gorin said. “Without the screening, however, there’s a higher probability of morbidity and potentially mortality. Mortality has been reduced through screening, and prompt treatment. If you catch people with cervical cancer earlier, the treatment procedures are also less invasive.”
The cervical screening tests could be performed either though a cervical swab that a woman does herself, similar to inserting a tampon, or through a urine test.
The authors also state that over time, as clinically-relevant biomarkers emerge for early diagnosis of breast cancer, in-home tests could be developed.
The rapid transformation that COVID-19 has forced upon health care institutions shows that changes can be made in workflow, provider training, and patient engagement that can facilitate growth in patient self-screening for cervical and colorectal cancers, the authors write.
“We are seeing a change in the way that health care systems are operating and the way patients are being screened,” Dr. Harper said, emphasizing that insurance companies already mail out colon cancer tests to their enrollees.
The authors emphasize that it’s important for doctors, insurance companies and health systems to work together to make the greatest and most efficient use of resources so that healthy people can remain healthy through appropriate preventative screenings and that those who need to see a primary care doctor can do so promptly.
“It’s important to use our clinical resources well,” Dr. Sheinfeld Gorin said. “It’s important for us to assess how we are doing to keep the patient in the forefront. It’s prioritizing time with the physician.
“This is also a COVID-19 world. We have to think more carefully about our distribution of resources from the policy and organizational perspectives,” Dr. Sheinfeld Gorin added. “As we saw with telemedicine, there was such a huge movement towards it and now it’s here. Perhaps the same kind of change will occur in home testing because of the necessity.”
Article Citation: Gorin SNS, Jimbo M, Heizelman R, Harmes KM, Harper DM. The future of cancer screening after COVID‐19 may be at home. Cancer. 2020. doi:10.1002/cncr.33274.