20 September 2021

COVID-19 lockdowns have seen us putting off a lot of things.
Our health shouldn’t be one of them.

I think most would agree that in this era of the coronavirus pandemic, lockdowns, in addition to mask wearing and vaccinations, have been a necessary step in curbing the spread of this highly contagious virus and protecting the health and safety of the entire community.

What people are not talking about however, is the impact the lockdowns have had on other aspects of our health. Aspects beyond the virus itself.

Taking a step back, let’s talk about preventative health care, which is the cornerstone of general practice. By definition, preventive healthcare aims to prevent illness and assist in the early detection of diseases while also promoting the maintenance of good health. In doing so this decreases the overall burden of illness on the individual and society. One of the most important aspects of preventative healthcare is cancer screening.  As I am sure a lot of you know, here in Australia we have national screening programs for bowel, breast and cervical cancer. In addition to that, we can also screen for other cancers such as skin, prostate and certain blood cancers to name a few. Screening people regularly, whether they have symptoms or not, ensures if something is awry it can be detected early which significantly improves long term outcomes.

Looking at bowel cancer specifically, up to 99% of bowel cancers can be treated effectively or better yet, even prevented, if detected early. Unfortunately, only about 40% of bowel cancers are detected at this early stage. By screening through the routine Faecal Occult Blood Test (yes that little kit the government gifts you for your 50th birthday) the chances of detecting bowel cancer at this early stage, before symptoms develop, dramatically increase.

For the past 18 months however, since COVID-19 hit Australian shores, this task has been incredibly challenging, for a couple of reasons. Firstly, state-based lockdowns have seen the temporary closure of several medical and screening facilities, for example BreastScreen NSW. And secondly, people just aren’t seeing their doctor for their routine checks.

Here is what the stats are telling us.

Over the past year, new cancer diagnoses are down almost 20%.  Normally we would say a reduction in cancer cases is a good thing, but in this case not so much. It is not that there are 20% less cases of cancer, it is just 20%, almost 1 in 5, aren’t being detected. In fact, research from one of Australia’s leading laboratories shows that in 2020, they received 18% fewer biopsies of skin, breast and bowel tissue to analyse. So what does this mean in real terms? Well, in 2019 there were 145,000 new cancer diagnoses in Australia. So if we extrapolate those numbers, that would mean potentially 58,000 people in the past 2 years will have either missed or delayed a potential cancer diagnosis.

Why? It goes back to what I was saying about the reduction in screening.

In 2020 when Australia first went into lockdown due to COVID-19, cervical cancer screening decreased by 71%. Similar reductions were seen in colonoscopies for bowel cancer screening. While these numbers have rebounded a little in 2021, they are still not back to their pre-pandemic levels.

This year however, the delta outbreak has impacted not only people’s willingness to present to their doctor for their routine cancer screening, but also people’s ability to physically access these services. In July, BreastScreen NSW temporarily closed due to the NSW delta outbreak, meaning thousands of women have been unable to access their regular mammograms for breast cancer screening. Additionally, all elective surgery in Sydney public and private hospitals has paused, meaning colonoscopies have also been delayed.

But we can also see the effects at a grassroots level, with a reduction of people presenting to their own GP for skin checks, cervical screening tests as well as their general health checks. While people cite many different reasons, the two most common are people not wanting to actually go into a doctor’s clinic for fear of exposure to the virus or others not wanting to place an extra burden on the healthcare system.

When it comes to burden however, screening is actually one of the most important steps in minimising the burden on our healthcare system. At the risk of repeating myself, screening regularly improves the chance of early disease detection and therefore minimises the need for long term treatment. There is a significant fear amongst health care professionals about a possible “tsunami” of advanced cancer diagnosis that may come in the next year as a flow on affect of the reduction in screening over 2020/2021.

While some screening such as cervical screening does need to be done in a doctor’s clinic, the great news is that some, such as bowel cancer screening can be done without leaving the house. No hours of sitting in a waiting room. No invasive or uncomfortable tests. Just a simple collection that is done from the comfort of your own home. With that in mind, really, we have no excuse not to do it!

So, if you take one thing from this please, just remember, your health never goes into lockdown.

Cancer won’t wait, so you shouldn’t either.

Dr Michela Sorensen
General Practitioner