Cancer chief warns delays in care likely to result in thousands of extra deaths

The government’s top cancer doctor warned Thursday that delays in screenings, diagnoses and treatment because of the coronavirus pandemic are likely to result in thousands of “excess” deaths from the disease in coming years.

Norman “Ned” Sharpless, director of the National Cancer Institute, said new estimates by the institute show there will be 10,000 more breast and colorectal cancer deaths over the next decade than would have been expected without the coronavirus. Those deaths represent about a 1 percent increase in the almost 1 million deaths expected from those malignancies in the next 10 years. Breast and colorectal cancer account for about one-sixth of all cancer deaths.

Sharpless said his estimates were based on a “conservative” analysis of the two cancers—perhaps too conservative, he said. The researchers estimated, for example, that there has been a 75 percent decrease in mammograms and colonoscopies in recent months, but now think the number might be 90 percent or more. In either case, he said, the estimates show that even a relatively short disruption of screening and care can lead to more deaths.

About 118,000 deaths in the United States have been attributed to COVID-19.

The cancer institute head spelled out Sharpless’ views in an editorial published Thursday by Science; he elaborated on them in an interview. He wrote that while there has been a steep drop in cancer diagnoses in the United States since the start of the pandemic, “there is no reason to believe the actual incidence of cancer has dropped.”

The result, he said, is that “cancers being missed now will still come to light eventually, but at a later stage (“upstaging”) and with worse prognoses.”

While delaying screenings and care was, to some extent, prudent during the height of the pandemic, “ignoring life-threatening non-COVID-19 conditions such as cancer for too long may turn one public health crisis into many others,” he added in the editorial.

He said doctors can take steps to try to keep the effects from getting worse. They need, for example to make patients feel comfortable about returning to hospitals, clinics and doctors’ offices for screening and treatment. “If we let them be afraid for six months or a year,” he said, “the numbers get worse and worse.”

His concerns are echoed by many oncologists and cancer centers.

“We are all worried there is a downstream ripple effect where screening studies were omitted completely,” said Margaret Van Meter, an oncologist who treats breast cancer at Intermountain Healthcare in Murray, Utah. Routine mammograms—for women without symptoms—were canceled for months at most facilities across the United States, while mammograms for women with symptoms typically continued.

Medical centers also postponed many cancer surgeries they deemed less urgent, such as early-stage breast cancers that could be treated first with medication.

Van Meter said some of her patients who were longtime cancer survivors were happy to switch to telemedicine visits and probably suffered no ill effects. Many newly diagnosed patients with aggressive malignancies have not hesitated to come in for treatment, she said. “When faced with two very serious threats, they are choosing to get cancer treatment,” she said. “They are taking precautions but have not been crippled by coronavirus fear.”

In addition to cancer treatment, Sharpless in the editorial expressed concern that an unprecedented disruption in cancer research may slow the development of needed therapies. “Given the long timeline between basic cancer research and changes to cancer care, the effects of pausing research today may lead to slowdowns in cancer progress for many years to come,” he said.