AARP Eye Center
The worst of the COVID-19 pandemic is likely behind us, but now there’s a new health care hurdle: getting people to return for recommended routine screenings, checkups and exams. With the country focused on the pandemic over the past two years, many people have re-prioritized preventive health care. Others, concerned about contracting COVID-19, have been delaying necessary doctor visits. “There has also been a general exhaustion with most things medical,” notes Cory Fisher, a family medicine specialist affiliated with the Cleveland Clinic.
In fact, 2021 research appearing in JAMA Oncology found that a whopping 9.4 million breast, colorectal and prostate cancer screening tests that normally would have taken place in the United States in 2020 — the height of the pandemic — didn’t happen. What’s more, recent findings, led by researchers at the American Cancer Society, show that the number of women in the United States who reported having a breast cancer or cervical cancer screening dropped by 6 percent and 11 percent, respectively, in 2020 compared to 2018. Colonoscopies, crucial for the early detection of colorectal cancer, fared even worse, dropping by 16 percent for both men and women — though, note researchers, that number was offset by an increase in stool testing (7 percent). Another study, led by researchers at Johns Hopkins Bloomberg School of Public Health, found that the number of primary care consultations — where cholesterol and blood pressure assessments usually take place — plummeted by more than 21 percent during the second quarter of 2020, compared with the same time period in 2018 and 2019.
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And although research shows that health screenings appear to be rebounding, they have yet to return to their pre-pandemic levels. Case in point: According to a June 2022 study, an analysis of the National Mammography Database, which evaluated data from over 5 million mammogram screenings at 377 facilities, the use of breast imaging services — including mammography screenings — returned to just 85.3 percent of pre-pandemic levels. Doctors worry that delays in screening could result in patients being diagnosed with more advanced, harder-to-treat health problems down the road.
The National Cancer Institute predicted in June 2020 that the pandemic would result in 10,000 excess deaths from breast and colorectal cancers alone over the next decade in the United States. Indeed, the consequences of delaying care are fast becoming clear. For example, new findings from researchers at Moores Cancer Center at UC San Diego Health found that about 64 percent of breast cancer patients were diagnosed at stage 1 in 2019, but that slipped down to 51 percent in 2020, the first full year of the pandemic. If you have put off cancer screenings and other preventive care during the COVID-19 pandemic, now is the time to get back on track.
When you need it: The U.S. Preventive Services Task Force issued recommendations in May 2021 that average-risk colorectal cancer screening should begin at age 45, not 50. Part of the reason for the change is that while death rates have been decreasing year by year, numbers have been increasing among people younger than 50. Health care experts don’t know the exact reason, though some suspect poor eating habits — including diets high in red meat and processed foods — may be a cause. “Now the universal message is, start [having the conversation about] screenings at age 45 and continue every 10 years thereafter if the results are normal,” says Aasma Shaukat, M.D., professor of medicine and gastroenterology at NYU Grossman School of Medicine. Those at higher-than-normal risk — say, smokers or those with first-degree relatives who have had colon cancer — should have the procedure every three to five years. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through age 75. For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health and prior screening history. Screening is not recommended for people over 85.
Why you need it: Though colon cancer is the most preventable cancer (caught early, the five-year survival rate is about 90 percent), it is the third most commonly diagnosed cancer and the third leading cause of cancer death in the U.S. Why? Only about 66 percent of adults over age 50 are up to date on colorectal screening, according to the American Cancer Society. The group estimates that, in 2022, 106,180 new cases of colon cancer and 44,850 cases of rectal cancer will be diagnosed in the United States, a majority of those in adults age 50 and older.
At-home stool sample tests, such as the fecal immunochemical test (FIT) or the DNA test (Cologuard), are very effective if done regularly (either once a year or, in the case of Cologuard, every three years). But the gold standard is still a colonoscopy. As experts point out, it’s a one-stop test: It not only discovers precancerous polyps, it removes them before they can cause trouble down the road. (It takes about 10 years for polyps to turn into cancer.) Also, if anything suspicious is found with a stool test, a follow-up colonoscopy will be needed.
Need a nudge? For many patients, the bowel prep before the procedure — which once required downing jugs of an awful liquid laxative — is the hardest part of a colonoscopy. But, Shaukat notes, there are now preparations that are half the volume of the regular prep (about a gallon of liquid, or about two liters). “You can also do things to make the prep more palatable,” she says. “Since a lot of these preps have a salty aftertaste, add flavored Crystal Light to the mixture and sip it on ice, with a straw.” If you just can’t stand downing that loathsome liquid, good news: Prepping for a colonoscopy now can be as easy as swallowing a pill — well, 24 of them. In 2020, the FDA approved a prescription prep tablet, Sutab, a laxative that clears the colon. How it works: A course of Sutab has 24 tablets, which are split up into two doses of 12 tablets each. You take the first dose of 12 tablets the night before your procedure, along with water, followed by more water, and the second dose (with more water) the morning of the colonoscopy, at least two hours before your appointment, to make sure your colon is completely clean. The downside: Some drug plans don’t cover Sutab. Discount coupons are sometimes available from the drug manufacturer.
When you need it: Breast cancer screening guidelines vary among medical boards. To keep it simple, many doctors recommend that women who are not at higher-than-average risk have annual screening mammograms beginning at age 40. The American Cancer Society recommends annual mammograms for women ages 45 to 54, with women age 55 and older continuing annual mammograms or switching to a mammogram every two years. (Breast cancer diagnosed in women over 55, especially those who have transitioned through menopause, is more likely to be slower-growing and less aggressive.) Women at high risk because of a family history of the disease or other factors, such as dense breasts or the presence of a BRCA gene mutation, likely need more frequent screenings. Mark Pearlman, M.D., one of the authors of the American College of Obstetricians and Gynecologists Practice Bulletin on Breast Cancer Risk Assessment and Screening in Average-Risk Women, says “women who have very dense breasts have about a four-fold risk of developing breast cancer in their lifetime, compared to women who have very fatty breasts.”
The American Cancer Society also suggests that women continue to undergo screening mammograms as long as they are in good health and are expected to live at least 10 more years.
Be sure to let your mammography technologist know if you’ve gotten the COVID-19 vaccine — along with how many doses you’ve gotten and in which arm it was administered. Why: In some women, breast cancer appears as swollen lymph nodes under one arm. Some patients have reported developing swollen lymph nodes after a COVID-19 vaccination. This finding could be mistaken for a potential breast cancer diagnosis.
Why you need it: Eighty percent of all breast cancers occur in women 45 and older. (Women ages 40 to 50 have a 1 in 68 risk of developing breast cancer. From age 50 to 60, that risk increases to 1 in 42. In the age group 60 to 70, the risk is 1 in 28.) Since 1990, breast cancer death rates have fallen between 1.8 percent and 3.4 percent per year — in large part because mammograms are good at finding breast cancer, especially in women age 50 and older, correctly identifying cancer 87 percent of the time.
Most medical organizations don’t recommend routine breast self-exams as a part of breast cancer screening. According to the Mayo Clinic, “that’s because breast self-exams haven’t been shown to be effective in detecting cancer or improving survival for women who have breast cancer.” Getting an annual mammogram is the best way to catch the disease at an early stage, when it’s less likely to have spread.
Need a nudge? It’s estimated that up to 50 percent of women skip mammograms because the procedure can be painful. Popping an acetaminophen or ibuprofen about an hour before your mammogram can help, Pearlman says. You can also try this breathing trick: Before the technician compresses your breast between the imaging plates, take a deep breath, then slowly exhale as the compression begins. (Breathing out helps your muscles relax.) Just be sure to hold your breath while the X-ray is being taken to avoid (yikes) retakes.