Published on May 18, 2020

  • The number of mammograms, colonoscopies, and tests for prostate cancer are dramatically decreased, prompting fears that 80,000 cancer cases could go undiagnosed.
  • People with signs and symptoms of cancer - a breast lump, changing mole, or rectal bleeding for example - shouldn't wait to be screened.
  • People with cancer are at higher risk for getting sick with the coronavirus and having COVID-19 related complications.
  • Using masks and following shelter in place and social distancing orders is critical to the health and safety of cancer patients.

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. I'm joined today by Dr. Len Lichtenfeld. He's the Deputy Chief Medical Officer of the American Cancer Society. Doctor Lichtenfeld, thanks for joining me.


JOHN WHYTE: You know, we've been telling patients to stay away from the hospital, don't come in. And they have been staying away. I saw a report, um, late last week that says 87% of mammograms are down, 90% of colonoscopies, nearly 60% of PSA tests. And there's the belief that this decrease in screening can lead to 80,000 fewer cancer diagnoses. How concerned should we be about this?

LEONARD LICHTENFELD: Obviously, John, whenever there's a change in a typical pattern, we all become very concerned. So, uh, that-- that's a given. Quite honestly, I am not surprised, personally, that we've seen those declines. The American Cancer Society, among other organizations, told people not to get-- people at average risk, I should add, not to get routine cancer screenings during this period of time. That the risk of going into a medical setting was higher than-- than the benefit of the screening. And again emphasizing people of average risk. And there's also no question in my mind that as we come out of this, as we begin to not get-- we won't get back to normal, but whatever that new normal is, we're going to see a backlog of people who will go get screened. And we will have an increase, consequently, of patients who are diagnosed with cancer.

My biggest concern is-- is really twofold. Number one, the people at highest risk get screened as appropriate. So let's say someone with the BRCA test. That people with a sign or symptoms that suggest they may have cancer, whether they have rectal bleeding, for example, or a breast lump, that they make sure they don't wait. That-- that's not screening. That's-- that's diagnosis. I think we'll work our way through this. But yes, there will be a delay. And we-- we will find out how much of an impact it actually has had.

JOHN WHYTE: American Cancer Society put out a report recently that talked about clinical trials in-- in cancer care. And the FDA has put out some guidances about how to minimize the number of, uh, blood draws that people need, tissue samples, et cetera. But it's hard enough to get people to enroll in-- in clinical trials. Are-- do you think we're going to be moving to clinical trials in home? Should patients just say, you know what, I'm not going to worry about it right now? But then-- then it becomes six months, a year, and then all of a sudden, we're not reaching recruitment, even to a worst degree than before.

LEONARD LICHTENFELD: There, again, is no question that clinical trials have been impacted. Some that were supposed to start didn't start, and some that did start, there have been problems getting the drugs to patients or continuing the treatment. So it's a major issue. We aren't really great in this country getting people on clinical trials in the first place. And so this disruption from the pandemic is not going to make that circumstance any better.

The research enterprise in general has been significantly impacted by COVID-19. And on the clinical side, as we're talking about here with clinical trials, but also on the basic research side. You know, we-- we did a survey. 50%, about 50% of the investigators can't-- you know, at the time we did the survey, couldn't get into their labs. The other 50% were severely restricted. And the same goes on the clinical side as well. So it will have an impact. And I know that-- that organizations are trying to do workarounds to make sure that impact is limited.

You mentioned clinical trials at home. Yes, they're trying to get the drugs to patients where they are, wherever that may be. And also, let's not forget the people who used to travel to some of these major institutions for a particular drug can't get there.

So, um, the story, unfortunately, I wish we had a better handle on the pulse of what's actually happening. We hear anecdotes, but we don't have much organized information. But I-- I sincerely hope, along with you, I'm sure, that we get this-- this-- this back on track as soon as we possibly can.

JOHN WHYTE: And how concerned should patients be when their protocols are adjusted? So maybe they were receiving an infusion and now they're receiving an oral medicine, you know, a pill. And you and I know that can cause a lot of anxiety on the part of patients. So what can we tell them? How-- how can we help them?

LEONARD LICHTENFELD: So I think that there's, you know, in every bad situation is always some good news that comes out of it. And medical organizations, first-- first off, physicians, oncologists, and surgeons, or radiation oncologists at local levels, have gotten together to try to figure out what's best for patients under these circumstances. But on a national level, we've seen reputable medical organizations come together and say what they think has to be done today and what they-- where the modifications can occur. So it's no longer happening in a vacuum.

When we first started, a lot of what we call ad hoc, a lot of decisions were made on the fly. But now it's getting back into an organization, and it's actually been fascinating to hear the experts on webinars who say, you know, we've taken a good look at this, and we think we can do it this way instead of that way, and there won't be any harm.

And by the way, there's research that suggests that what we're doing, these changes won't be a problem. But yes, when you're a patient and you have cancer and you want to be treated and you want to get the best treatment possible, any changes is a problem. One thing that I would want to point out. It's going to be the health care we need, and it may not be the health care we want.

But I know that every oncologist, particularly those involved in cancer care, are doing their utmost, doing their best to make sure the patients, uh, have the least-- least inconvenience, and frankly, the least harm from any of the adjustments that have to be made.

JOHN WHYTE: What do cancer centers and hospitals need to start doing to help patients recognize, depending upon what's happened in their local community, that it's safe to come back into the hospital? To your point at the beginning, we told them it's-- it's not safe. It was also, we didn't have enough equipment in terms of, you know, personal protection.

But how do they know that, you know, maybe it's safe to consider that colonoscopy, even at average risk? Because we know those are often delayed, that we know it's time, you know, to get some blood draws. Blood draws our 90% down. You know, who's getting any type of blood test that's not COVID-related?

So there is a communication issue, I think, in terms of, you know, we told them it's not safe to come in. Now we're starting to say it might be. Soon we'll be saying, you know, under these circumstances, you can come in. Let's be honest. That can be confusing to patients, and in patients with cancer who are very anxious.

LEONARD LICHTENFELD: John, there's no question. I mean, first off, let's understand, all of the communications surrounding this pandemic has been confusing. Uh, and, you know, for-- for the general public, they've gotten so many mixed messages. And one-- one place does one thing, another place does another thing. Maybe there's equipment, maybe there's testing, no, there isn't. So-- so all-- everyone is confronted. Including me, and you, and all the medical community, are confronted by mixed messaging. Um, you know, I-- this is really going to put a responsibility on the shoulders of the medical community in particular, when we're talking about health care.

The medical community, the medical facilities, the medical institutions, the universities, the cancer centers, whatever it may be. It's going to put a major responsibility on their shoulders to show the patients, the public, that-- that, in fact, they're taking every step possible to keep everyone safe in a difficult situation. We're not going to go back to normal. There's not going to be a day, uh-- there was-- there actually were some predictions about what that day may be, literally for different parts of the country. That's gone. I mean, we're now-- each-- each day is another day.

So medical facilities, doctors, patients, nurses, health professionals of every type, have to make sure they put patient safety as a priority, and that they prioritize who has to come in earliest, who does need that blood draw now, and frankly, who can wait. You know, sometimes, instead of a colonoscopy, maybe this year it can be a stool test for blood. Maybe that's what we do.


LEONARD LICHTENFELD: Maybe you don't need a-- a mammogram every year. Maybe if you're 60 years old at average risk, you can get it every two years. That's-- the American Cancer size says that's OK, as do other organizations. So, you know--

JOHN WHYTE: But as you know, patients often don't know whether they're at average risk or not. There's a lot of misunderstanding about that. And certainly to your point early on, if-- if people are having symptoms, they feel a lump, they have bleeding, they have a mole that, you know, is rapidly changing, that's not screening. And in some ways, that requires something different. So we have to make sure we give patients good information too. What advice would you and American Cancer Society give for-- for cancer patients, their families, who are often part of, you know, the entire treatment process, during this pandemic?

LEONARD LICHTENFELD: So cancer patients, unfortunately, are at a special risk, higher risk of getting complications of COVID-19 or getting it if they get the infection in the first place. So we have been sharing that it's really important for cancer patients and their families to take this seriously, to protect themselves as much as possible, especially if they're on treatment or recently been in treatment. And even some studies suggest as far out as three years they've had chemotherapy, there may be some problems. And there may be some disagreement about that. But the-- the point is, is important.

Take care of yourself, shelter in place, follow the recommendations, be around people who use masks, wash your hands, socially distance. And families can have a huge role in making sure that their loved ones stay safe. It may be a matter of doing the grocery shopping and making sure that a parent is-- is-- is cared for properly. But extra special caution. When we say wash your hands, wash your hands. Use hand-- you know, hand sanitizer. Use hand sanitizer.

All those things, all those messages are-- are what's most important to keep yourself safe. That's actually true for everyone-- everyone, but especially for patients with cancer.

JOHN WHYTE: Well, Dr. Lichtenfeld, I want to thank you for taking time today.

LEONARD LICHTENFELD: And Thank you. It was a pleasure.

JOHN WHYTE: And I want to thank you for watching Coronavirus in Context. I'm Dr. John Whyte.