A 'five-figure increase' in cancer-related mortality — How 5 GIs are shrinking the screening backlog

COVID-19 delayed screening colonoscopy procedures in most states across the U.S., and with cases continuing to rise across the country, the effects of a second delay could have long-term and disastrous ramifications.

Here, five gastroenterologists explain how their practices approached the screening backlog and offer insights into the ramifications of further delays.

Note: Responses were edited for style and content.

Question: How has your practice approached the screening backlog?

Anezi Bakken, MD, gastroenterologist of Center for Digestive Health Michigan in Troy: We resumed screening colonoscopies per guidelines from the CDC and the state of Michigan. Our schedulers had a list of deferred patients and contacted them to schedule their screenings. We have opened the ASC on some Saturdays for procedures and inform the patients of all the measures we take to protect them and our staff. [Those include] testing all patients for COVID-19 48 hours before their procedure, and we have strict protocols still fully in place at the center for staff. This has been very reassuring to patients to know we are making all efforts to keep the centers COVID-free and they feel more comfortable scheduling their screening.

Brian Dooreck, MD, gastroenterologist at Gastrointestinal Diagnostic Centers in Pembroke Pines, Fla.: Safely. Responsibly. Consciously. With empathy and a lot of communication addressing any fears [or] concerns, and with reassuring support of our planning to meet the standards of safe, necessary medical care.

Alan Gunderson, MD, gastroenterologist at University of Iowa Hospitals and Clinics in Iowa City: We are in a special position, without an unwieldy case backlog. For months our institution has been performing COVID-19 diagnostic testing 24 hours before all ambulatory procedures with a return result within about six hours. With negative diagnostic testing in an asymptomatic population, we have continued screening for [colorectal cancer] at or near our previous rate.

Asma Khapra, MD, gastroenterologist at Gastro Health in Chantilly, Va.: First, we have increased endoscopy sessions for physicians during the week, [increased volume to 100 percent in] another [procedure] room in our endoscopy center that was only functioning [at] 50 percent prior to COVID, and additionally, we have opened a few Saturday sessions to perform procedures.

Amir Masoud, MD, gastroenterologist at Yale New Haven (Conn.) Health: We have a dedicated team that catalogued all deferred procedures at the height of the pandemic, then once we were given the okay to resume operations, rapidly went through these to book them, depending on urgency. Prior to opening, we put many safeguards and enhanced safety protocols in place for patient and provider safety and were careful to highlight these to our patients to improve show rates and confidence.

Abhishek Watts, MD, pediatric gastroenterologist at Mercy Hospital in Springfield, Mo.: We have now been doing elective procedures in the order they were scheduled. Every patient is [tested for] COVID-19 before the procedure. If [the patient is] positive, only emergent procedures are performed and elective cases are rescheduled.

Q: If the second wave of COVID-19 cases delays in screenings, how could colorectal cancer risk increase?

AB: That would be unfortunate for patients who may then have a delay in diagnosis of early colon cancers or removal of precancerous polyps. This would clearly increase the risk of CRC in many patients.

BD: The numbers were astronomical of the delayed or missed CRC diagnoses from March and April 2020 due to COVID. Financial implications aside, this was horrible to read and phantom the real-life implications to people and their families.

AG: I think that our present practice will prevent significant case backlogs. If someone tests positive for COVID-19 and never develops symptoms we can reschedule them within about 2 weeks time in most instances.

AK: We have taken a great financial hit earlier in the year due to closures related to COVID. We are fearful of that occurring again. I addressed the impact of delaying screening colonoscopies [in a webinar]. For instance, CRC diagnoses were down by 33 percent during the height of the pandemic. The [costs associated with] this will be immense in terms of [preventable deaths]. The first week [we reopened] our center fully, I diagnosed two CRC cases. The impact of COVID-19 has been tragic, and we are hoping to avoid a second wave of the same magnitude.

AM: There is data to suggest that screening delays for CRC by colonoscopy and breast cancer by mammography may lead to a five-figure increase in cancer-related deaths over the next decade. We are keenly aware of this risk and go to great lengths to make sure nobody "falls through the cracks."

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