Breast cancer care and screenings dropped during COVID, delays could

Glenda Dunn, 55, of Appling has the masks and hand sanitizer by the front door for a reason, and it is not negotiable.

“If you come in my house, you’re going to put a mask on,” said Dunn, who is undergoing treatment for breast cancer. “They are getting it and sanitizing. If they don’t want it, they are on the front porch.”

Dunn, whose immune system is compromised by her treatment, was diagnosed late last year in the midst of the COVID-19 pandemic. The disruptions in care, diagnosis and treatment for patients like her have not only had an immediate impact on their health but will have grave consequences for some far into the future, physicians said.

National Cancer Institute Director Norman Sharpless estimated that the disruptions caused by the pandemic will result in 10,000 additional deaths just from breast and colon cancer over the next 10 years. Another estimate, published in The Lancet Oncology, predicted breast cancer deaths will rise as much as 9.6% over the next five years due to delays in diagnosis.

Those disruptions were worse at the beginning of the pandemic. Researchers looking at the National Breast Cancer and Cervical Cancer Early Detection Program, which helps low-income and uninsured women get screenings, saw an abrupt 87% drop in breast cancer screenings in April 2020 compared to the average for the same month over the last five years, from 19,366 to 2,607, according to the study in Preventive Medicine. While the rate had recovered somewhat by June, it was still down 39% compared to previous years, the study found

Even those short delays can have consequences, said Dr. Alicia Huff Vinyard, a surgical oncologist at Georgia Cancer Center at Augusta University.

“The mammogram is where we catch it before you can even feel it, and we catch it at a much earlier stage,” when it is more treatable, she said. “We have had some patients pushing off mammograms for six months to a year. And then, unfortunately, we find a small cancer or a more advanced cancer because of that delay.”

That was the case for Jeanne Harrison, 76, who had faithfully received her mammogram at AU Health for 25 years because her mother had cancer in both breasts. Then last year she had to miss it because of the pandemic, which she feels many women did.

“There were a lot of us who didn’t want to go into the hospital because of the virus,” said Harrison, a retired attorney. But then she was doing a self-exam and found a small lump in her right breast, which Dr. Vinyard removed with a lumpectomy. Even with that, she counts herself lucky.

“I was very, very fortunate it wasn’t worse than it was,” said Harrison, who still faces radiation therapy and a year of chemotherapy.

It wasn’t just the diagnoses that were delayed. During this most recent surge of COVID-19, administrators at AU Medical Center were so short of Intensive Care Unit beds that they converted a surgical recovery room into a temporary ICU. Vinyard needed that room for a patient already scheduled for her breast cancer surgery, which then had to be put off. Fortunately, it was an outpatient case and Vinyard got her into the Surgery Center of Columbia County about 10 days later but the delay took a toll on the patient.

“Mentally, that was tough for her. She told me it was,” Vinyard said. “She knew there was nothing we could do about it.”

More: Georgia Cancer Center outreach aimed at disparities in Augusta

More: ‘Really bad disparities’: Rural areas, Black people hit hardest in Georgia during pandemic

Even with the COVID-19 pandemic waning, cancer patients with their weakened immune systems are under constant threat from infection.

“That’s a huge risk,” Vinyard said. Her patients are at “much greater risk of infections and serious complications because of their inability to mount a good immune response,” she said.

It’s why Dunn always carries antibacterial cloths with her when she goes out. “Anywhere I go that is not home, I’m going to wipe it down,” she said. “You can call me paranoid if you want to but I am just being cautious because I know my immune system is compromised.”

It is also why the cancer center has to remain cautious about who is allowed around their patients. So often, family and friends that would normally accompany patients on visits for support can’t be there. In one case during a COVID-19 surge, it was a woman undergoing a double mastectomy.

“That young woman had to be dropped off and picked up by her husband, he wasn’t able to be there at all during that entire process,” Vinyard said.

That crucial lack of support hits all of her patients.

It’s the  “same for my other patients who are going through chemo by themselves, who are having surgery, and no one is there to give them a kiss on the cheek before they roll back to the operating room,” Vinyard said. “It’s definitely very different than what we’ve been able to provide our patients in the past.”

Vinyard’s own bout with COVID-19 affected Dunn’s care. The doctor was diagnosed last December, a day before she was to receive her first shot of vaccine. She was in quarantine when she delivered the results of Dunn’s biopsy.

“I actually had to give her those results virtually, which is just not the same,” said Vinyard, who likes to sit down with the patient and the family and go over what was found and the treatment options, and might also do a physical exam. “She handled the news very well, and we talked about what would be the likely treatment options. But that was really tough to give that kind news while I am still in quarantine and can’t do anything else.”

Vinyard knows just how important that personal contact and having that support can be to patients because she is a breast cancer survivor herself. In Dunn’s case, her support never left her side. it was her husband, Alonzo.

“It’s been a little tough (because of the pandemic),” she said. “But my husband is very strong and he keeps me going. He has been with me through thick and thin. He’s never missed an appointment with me.”

The two, who have known each other for more than 45 years as they grew up in Appling, have become more than close, Alonzo said.

“You do mesh into one,” he said. So not going with her for each visit was not an option, Alonzo said.

“I had to be there for her,” he said.

Alonzo has a way of making her feel better about anything, Dunn said.

“I tell you one thing, if laughter is the best medicine, I can live forever, as long as he is here,” she said. “He makes me laugh every single day.”

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