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At-home cancer screening could thrive after the pandemic

Reuters Health - 23/11/2020 - Cancer screenings have dropped across the board during the coronavirus pandemic, yet home screening for colorectal cancer decreased less than in-person methods, which could suggest a potential option for the future, according to a group of doctors.

At-home tests, paired with follow-up telemedicine appointments and in-office diagnostic tests, may open up new avenues for patients to access care and obtain regular screenings, particularly for breast, cervical and colorectal cancers, they write in Cancer.

"The virus continues to plague us, and our public health system is still struggling to control the resurgence. We may yet experience additional closures that would impact routine preventive visits, such as those for cancer screening and vaccinations," said lead author Dr. Sherri Sheinfeld Gorin of the University of Michigan School of Medicine in Ann Arbor.

Missed or delayed screenings can lead to late diagnoses and late-stage-cancer development, she explained. Patients who don't receive a cancer screening in a timely manner could face severe disease, as well as financial issues and quality of life concerns associated with the surgery, radiation and chemotherapy needed to combat advanced cancer.

"We know that these closures, and the attendant decrease in in-person screening, have adversely affected vulnerable patients, such as those at familial risk for breast cancer, with likely increased morbidity and mortality from cancer over time," she told Reuters Health by email.

Dr. Sheinfeld Gorin and colleagues analyzed electronic medical records for nearly 43,000 adult patients who received breast, cervical and colorectal screenings in May and June 2017-2019 to understand how shelter-in-place restrictions affected screenings in March to May 2020.

Before the pandemic, screening rates for the three cancers were on the rise across the country, on average. During stay-at-home orders, however, screening rates dropped dramatically, and they continued to remain low as clinics began to reopen in May and June, as compared with 2019 numbers.

Although at-home testing for colorectal cancer wasn't common before the pandemic, the testing method only decreased by about 65% during the pandemic. As office visits resumed during the summer months of 2020, family medicine doctors still reported an 88% decrease for in-person visits as compared with 2019. Video, phone and online portal visits rose tremendously.

"Home-based screening may be more immune to the impacts of a pandemic and its after-effects," Dr. Sheinfeld Gorin said. "Importantly, home cancer screening is a viable alternative to in-office cancer screening."

Stool-based screening tests that can detect colorectal cancer are currently available in the U.S. After a positive result, doctors can follow-up with patients and schedule the required in-office tests such as a colonoscopy or colonography to confirm a diagnosis.

The U.S. Food and Drug Administration is also reviewing an at-home cervical-screening test, and a biomarker-based home screening test for breast cancer could soon be available.

At-home tests could also help vulnerable groups to obtain screening, particularly those with disabilities, rural residents and low-income individuals. Doctors can teach patients how to collect the samples, which can also reduce the embarrassment that may accompany in-office visits for these three cancers.

"We still struggle to reach those who are underscreened, and home-based tests have been implemented successfully in many international countries, particularly Australia and across Europe, which has been shown to address barriers such as time, transportation and other factors," said Dr. Diana Buist of Kaiser Permanente Washington Health Research Institute in Seattle. Dr. Buist, who wasn't involved with this study, has researched home-based cervical-cancer screening.

This week, Dr. Buist participated in a virtual meeting of the President's Cancer Panel, which serves as an advisory team that reviews the National Cancer Program. Participants talked about the implications of the pandemic and strategies to move forward with cancer screenings next year. At-home tests could help, as well as better follow-up practices and telemedicine options after patients take a test.

"This isn't just about screening - it's also about the coordination of post-screening care," she told Reuters Health by phone. "When patients receive a positive result, we need to ensure they have an opportunity to receive follow-up care and don't face barriers with diagnosis and treatment as well."

SOURCE: https://bit.ly/35NFH21 Cancer, online November 10, 2020.

By Carolyn Crist

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