As states ease quarantine restrictions — and in the wake of widespread protests — coronavirus infections are rising, with the largest single-day increase just this week. Texas, South Carolina, California, Arizona, and Florida are all seeing upticks. And while we’ve all got cabin fever after living on lockdown for months, oncologists say cancer patients and those with compromised immune systems need to remain vigilant.Read More
Keep Your Guard Up
New data presented at annual American Society of Clinical Oncology (ASCO) meeting shows that people with cancer have nearly twice the chance of dying from the virus within 30 days of contracting it. If a cancer is spreading, a person’s risk level is elevated to 5 times that of an average person. Factors like overall health status also play a role in infection outcomes.
Patients at the highest risk are those who’ve had stem-cell transplants, those with blood cancers, and those in active treatment. The rules apply for household members, as well:
“We’re seeing young people saying ‘I don’t have to worry about it’, but if you live with someone who has had cancer or is under treatment, you can bring that virus back into that home,” says Dr. Leonard Litchfeld, acting chief medical officer for the American Cancer Society. “You may be a carrier and you may never know it.”
Remain Wary of Travel, Public Transit
Because even local travel increases your risk of exposure, staying home remains the best way to protect yourself and others from getting sick, the CDC says. If you must use a ride-share or take public transit, wear a mask and wash hands before and after the trip and
keep your distance, remaining 6 feet from people who are not in your household.
Because of the pandemic, some doctors are opting to postpone surgery and begin treatment with chemotherapy, says Dr. Ramez Eskander, a gynecologic oncologist at UC San Diego School of Medicine.
Don’t Avoid The Doctor
Oncologists are concerned that fear of the virus is preventing patients from getting cancer symptoms checked. “People are concerned about going into a medical environment, but care teams need to create a safe environment for patients coming in,” says Dr. Lichtenfeld.
“If you’re having a symptom, you don’t wait until the pandemic has subsided. You contact a doctor and get it checked. That’s my top of mind concern,” he told SurvivorNet.
Scheduling Screenings? Be Persistent
As cancer screenings resume, the influx of patients means you’ll need to push. Cancer screenings have dropped by 90% or more. Now, as restrictions ease and call-lines open, Dr. Lichtenfeld says those with cancer risk factors should “ask for priority scheduling,” when booking screenings, like mammograms or colonoscopies.
This is no time to be shy, he says: “As we start to open up, it’s a concern that those with risk factors get priority — we need to make sure that people who may not have as loud a voice are protected,” he says. Dr. Lichtenfeld hopes that
Dr. Zuri Murrell Director of the Cedars-Sinai Colorectal Cancer Center on colonoscopy screening to remove polyps — and cancer risk.
screening centers will push those people at higher risk to the front of the line but, he cautions, “there’s no rulebook right now.” Self-advocacy can be as simple as speaking up about
your risk factors when you make your appointment. If you have a BRCA gene mutation, for example, or a family history of cancer, let the person on the phone know: You need to be seen sooner, rather than later.
Ideally, screening centers will adjust their hours — adding evening appointments, perhaps — to accommodate the influx of patients. But, Dr. Lichtenfeld cautions, “access will be limited because of spacing of patients — waiting rooms will be emptier — but it’s important that we get the patients who really need to be there in the door.”
Diagnostic vs. Screening Tests
It’s also a good time to track your screening history, Dr. Lichtenfeld stresses. When was your last mammogram? Are you due for a colonoscopy? Is it time to see a dermatologist for full-body skin check? Check The American Cancer Society’s full list guidelines to confirm you’re on track.
For anyone who has noticed symptoms — a breast lump, a suspicious mole, or unusual bleeding — don’t wait for a screening appointment, “Call and get it taken care of today,” says Dr.Lichenfeld. “You don’t wait four months until the pandemic has subsided to get it checked,” he
Dr. Connie Lehman, Chief of the Breast Imaging Division at Massachusetts General Hospital in Boston on when to get a mammogram.
emphasizes. “You go now. That’s my top-of-mind concern, people who know something is wrong, but they’re hesitating to contact a doctor to get it checked.”
This kind of visit isn’t about screening, it’s a diagnostic exam and can be a crucial step in detecting a cancer early, when it’s easier to treat.
Some oncology centers are now offering virtual clinics to allow patients to follow-up on concerning symptoms. At NYU Langone’s Perlmutter Cancer Center, the Suspicion of Cancer Virtual Clinic enables people to speak with a cancer specialist from the comfort and safety of their homes. Look for similar programs in your area, if you have concerns about venturing into a clinical setting.
At Screening Visits: 5 Tips To Stay Safe
- Try to book appointments early in the morning when people are working to avoid crowds
- Wear a mask and gloves to the appointment
- Wash hands once entering and leaving the hospital — carry hand sanitizer and use it
- Remain six feet distance from other patients
- Ask hospital staff how often they are sanitizing equipment and keeping the facility safe
Cancer Screening Guidelines
Screening tests are used to find cancer before a person shows symptoms. The American Cancer Society’s guidelines can help you stay on track and guide you when talking with your doctor about screenings.
Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms. By age 45, women should get mammograms every year. Women 55 and older may opt for mammograms every two years, or continue yearly screening.
Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. Some women – because of their family history or other risk factors such as dense breasts – should be screened with MRIs along with mammograms. Talk with a health care provider about your risk to determine your ideal screening plan.
Colon and Rectal Cancers and Polyps
For people at average risk, The American Cancer Society recommends starting regular screening at age 45. This can be done either with a stool-based test or a colonoscopy. (Any abnormal test result needs to be followed up with a colonoscopy.) Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage. If you’re in good health, continue regular screening through age 75.
For people 76 through 85, discuss continued screening with your health care provider. People over 85 should no longer get colorectal cancer screening.
Cervical cancer screening should start at age 21. Women between the ages of 21 and 29 should have a Pap test done every 3 years. HPV testing should not be used in this age group unless it’s needed after an abnormal Pap test result. Women 30 to 65 should have a Pap test plus an HPV test (called “co-testing”) done every 5 years. This is the preferred approach, but it’s also okay to have a Pap test alone every 3 years. After age 65, women who have had 10 years of regular cervical cancer testing with normal results should not be tested for cervical cancer.
Some women – because of their health history (HIV infection, organ transplant, DES exposure, etc.) – may need a different screening schedule for cervical cancer. Talk to a health care provider about your history.
The American Cancer Society recommends that at the time of menopause, all women should be told about the risks and symptoms of endometrial cancer. Women should report any unexpected vaginal bleeding or spotting to their doctors.
Some women – because of their history – may need to consider having a yearly endometrial biopsy. Talk to your health care provider to determine your needs.
The American Cancer Society recommends yearly lung cancer screening with a low-dose CT scan (LDCT) for certain people at higher risk for lung cancer who meet the following conditions: Are aged 55 to 74 years and in fairly good health and currently smoke or have quit smoking in the past 15 years and have at least a 30 pack-year smoking history. (A pack-year is 1 pack of cigarettes per day per year. One pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack-years.)
Before getting screened, you should talk to your health care provider about y how you can quit smoking – if you still do, the possible benefits, limits, and harms of lung cancer screening, where you can get screened. Also discuss coverage with your insurance provider.
Starting at age 50, men should talk to a health care provider about the pros and cons of prostate cancer testing. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. African American men, or those who have a father or brother who had prostate cancer before age 65, should have this talk starting at age 45. If you decide to be tested, you should get a PSA blood test with or without a rectal exam. How often you’re tested will depend on your PSA level.