12 October 2020

Our ambassadors Dr Michela Sorensen talks about Covid-19’s impact on preventative health care.

I think most would agree that in this era of the coronavirus pandemic, lockdowns 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. Since the pandemic however, this task has been incredibly challenging because, well quite frankly, people just aren’t going to the doctor for these kinds of check ups. Here is what the stats are telling us. Since March 2020, new cancer diagnoses are down 30%. Normally we would say a reduction in cancer cases is a good thing, but in this case it is actually not great news. It is not that there are 30% less cases of cancer, it is just 30%, almost 1 in 3, aren’t being detected. In 2019 there were 145,000 new cancer diagnoses in Australia, with that number predicted to rise to 150,000 in 2020. So if we extrapolate those numbers, that would mean potentially 45,000 people will be either missing or delaying that cancer diagnosis. Why? It goes back to what I was saying about the reduction in screening. In April, as the pandemic was first taking off in Australia, cervical cancer screening decreased by 71%. The numbers have rebounded a little, however screening rates remain about 20% lower than this time last year. Similarly, the number of tissue biopsy results received by the laboratory (e.g. a mole that a doctor was concerned about so went of to perform a biopsy) were down by 56% in April. Since June these number have started to head in the right direction, but again they are still 15% lower than previous years. There are multiple reasons for this reduction in screening, however the two most common reasons cited 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 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 this year. 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 (B.Med, FRACGP)