Importance of Continued Cancer Screening during a Global Pandemic

There is no denying cancer screening transformed cancer care, as it aims to detect cancer before the appearance of symptoms. Timely screening has proven to be an effective tool in early diagnosis and decreasing cancer mortality rates. With early screening and engagement, health professionals are able to connect with patients sooner and tailor treatment plans to individual screening results and tumor characteristics, ultimately enhancing patient outcomes.

This initial step in cancer care has been dramatically altered due to the global pandemic. The Centers for Medicare & Medicaid Services in the United States have classified screening as a low-priority service and suggest healthcare organizations to consider postponing screenings. Many patients are also fearful of exposure to the COVID-19 virus or of overburdening healthcare services and thus have been less likely to present to healthcare services for cancer screening and diagnosis. As a result, the number of tests to screen for cervical, breast and colon cancer fell by 85% or more after the first COVID-19 cases was diagnosed in the U.S..

85% of Cancer Screenings in US Delayed

Cancer progression has not paused, and the impact of delayed screening may be drastic. The dip in the number of screenings is concerning as it jeopardizes our ability to diagnose disease early. It will also become more challenging for health systems to recover quickly and resume screening and diagnostics the pandemic intensifies and continues over time.

As the world is still in the midst of a global pandemic, healthcare administrators and systems, need to plan and adapt to allow patients to receive regular screening services in a way that minimizes community spread of COVID-19. For instance:

  • COVID-19-free facilities should be ideally located in sites separate from acute-care hospitals
  • If it is not possible to geographically separate  COVID-19 facilities and cancer-care facilities, separate spaces should be designated in mixed-care sites, with dedicated access and admissions processes for patients with cancer
  • Cancer care services should be delivered by a designated team of providers to reduce the risk of exposing COVID-19-free patients and healthcare workers to the virus
  • Patients should be screened with strict rules of admitting, such as only allowing patients with no symptoms suggestive of COVID-19, have self-isolated for 7–14 days, and/or have tested negative for COVID-19 test.  Staff at facilities could be trained to screen patients prior to scheduling appointments and at the time of appointment

It is also important to develop a program of testing and triaging to determine which patients require immediate screening on the basis of clinical need. This may require rescheduling of non-essential follow up visits or diverting these visits to telemedicine if available. Visits past the five-year mark for patients with no evidence of disease or concerning symptoms should be considered for rescheduling when clinical, laboratory, and imaging reports suggest low risk for recurrence.

These changes to screening will require active monitoring of waiting lists, communication with patients remotely, and enhanced communication between providers and facilities. Screening for cancer is a process that involves many moving parts, from primary care clinics, hospitals, and imagining facilities. Health systems will need to adopt new technologies to engage with patients and healthcare teams in a centralized and coordinated manner. As a leading provider of comprehensive care coordination solutions, Equicare Health can facilitate this process.  Equicare Health’s platform bridges the gaps and seamlessly connects health professional team members to each other and their patients

For instance, lung cancer screening programs have been altered during the COVID-19 pandemic as the risks from potential exposure to COVID-19 and resource allocation that has occurred to tackle the pandemic. This has altered the balance of benefits and harms of screening.  Performing a screening examination, and the evaluation of lung nodules, now carries an added risk. To date, health providers and hospital systems have been independently determining how to modify their screening and nodule management programs during the pandemic. For jurisdictions that are of low risk of COVID-19 transmission, Equicare Health’s standardized follow-up template to track lung screening patients and collect data that can be uploaded to the American College of Radiology (ACR) Lung Cancer Screening Registry may be an advantageous tool to minimize the risk of virus transmission.

Additionally, Equicare can help enhance communication with patients and increase their engagement in their care journey through the patient portal. The portal allows patients to connect directly with their care team. For example, patients can respond to electronic questionnaires to facilitate triaging of care. Once in the portal, patients can access individualized information, such as their test results, educational material, as well as their telehealth appointment schedule. Regular visits to the portal will help patients and their caregivers keep up-to-date on the progress of their journey and maintain contact with their care team without physically visiting a healthcare site. This can improve the experience of care for both patients and providers, and helps facilitate the continuation of cancer screening during this global pandemic.  

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses and health systems.

Cancer Care: From screening positive to diagnosis, and oncology team connection

Cancer screening procedures strive for effective early detection. In order to screen large numbers of at risk individuals, screening practices need to be simple, cheap and efficient. Diagnostic tests are used to determine the presence or absence of cancer. Symptomatic individuals, or individuals with positive cancer screening results, go through potentially invasive and expensive diagnostic procedures to establish the presence of a tumor.

As the cancer journey is complex and convoluted, the patient needs to meet with health professionals with different skill sets to facilitate the process. An oncologist oversees a patient’s care from diagnosis and throughout the course of treatment. Patients consult with their general practitioner and, at times in combination with, health insurance providers to be referred to the most appropriate oncologist. Databases, such as the American Society of Clinical Oncology (ASCO) [1], also provide open access lists.

Within the United States, approximately one third of patients aged 0 – 64 years (a population of approximately over 90 million) are referred to a specialist by their primary care physician [2]. A well-coordinated referral system needs to be established to accommodate this high frequency of referrals, in addition to connecting primary and specialty care.

All members of the oncology care team (oncologists, general practitioners, radiologists, nurse navigators, patient coordinators, registered dietitians, etc.) play an integral role in enhancing the quality of care received. The care provided encompasses diverse aspects of health services. In addition to appropriate care that is timely and appropriate, other elements of cancer care include psychosocial assessment, suitable and timely referral, and individualized treatment that considers each patient’s needs and preferences. A multidisciplinary team is needed to address these tasks, which may create complexities to care coordination in both hospital and community settings. Challenges include recognizing health professional roles and responsibilities, communication between the care team and with the patient, managing scarce resources, and transitioning patients through care.

Digital technologies have aimed to address these challenges [3]. These include:

  • Electronic portals

  • Electronic Health Records (EHRs)

  • Patient reported outcomes measures

  • Patient-centered education

They are utilized to enable collaborative care coordination systems. Patient experience and outcome is enhanced when implementation of optimal technologies are coupled with proper training and support for patients and the care team.

Recent evidence-based research has proven that improving quality of care through enhanced communication and a well-coordinated system is advantageous for the patient, the medical team, and healthcare system. Researchers have embarked on a series of studies aimed at identifying quality measures. Two examples of these cover:

1. The impact of EHRs and oncology EMR tools used by multidisciplinary teams in GP-oncologist communication and facilitation of cancer care. [4]

2. Use of IT-enabled measurements and patient reported outcomes by patients and the care team to enhance patient-centered care (allowing for a seamless incorporation of patient perspectives into cancer care practices). [5]

As a patient moves through from screening and diagnostics to workup, treatment plan, and the care planning stages – clear communication, education tools, and access improve patient engagement.

In our next article, we will take a closer look at different ways of engaging patients and their caregivers (e.g. patient portals, patient reported outcomes, and patient-centred education), and how they can ultimately improve the quality of health outcomes.

Main resources:

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Impacts of Cancer Screening on Patients, Oncologists, and the Care Process

Cancer screening revolutionized the world of cancer care with its aim to detect cancer before symptoms appear. Early detection is paramount for the control of any disease. When symptoms are detected or apparent, diagnostic tests are used to find out the cause of the symptoms. A procedure, ranging in complexity and invasiveness, can have significant influences on detection, diagnosis, and trajectory of care. Once detected, engaging an oncologist early and connecting the screening results to the expertise needed enhances patient outcomes.

There are different cancer screening procedures in use across the range of cancer types. In the case of breast cancer and colorectal cancer, early detection is correlated with lowering mortality rates [1]. There are times that early detection does not lengthen the life of the patient, but may have other benefits with creating patient awareness. In general, screening tests are recommended and offered to all at-risk individuals, regardless of the outcome. This makes it imperative to be aware of the positive and negative impacts.

Two procedures that have been proven to be very effective at reducing cancer mortality rates are colorectal cancer and breast cancer screening. Colorectal cancer is the second leading cause [2] of cancer deaths in the United States. It mainly develops from abnormal growths in the colon or rectum. Screening tests can identify these abnormal growths. They can also detect tumors, and prevent the development of cancer before growths metastasize.

Interestingly, breast cancer mortality rates are lower than colorectal cancer rates. However, the rate of breast cancer diagnosis are higher within American women [3]. How is it that death rates are lower and diagnoses are higher for breast cancer, when compared to colorectal cancer? The answer is complex and depends on the screening tools used along with the nature of the cancer type and stage. Mammography is currently the most commonly supported screening procedure for breast cancer. Its greatest benefit is the decrease in breast cancer mortality: mammography screening has been associated with a 15% to 20% reduction in breast cancer mortality in women aged 40 to 74 years [4]. Despite the differences between colorectal and breast cancer, it is evident that timely and regular screening is key in lowering mortality rates.

An example of where early screening does not necessarily decrease mortality rates is the prostate-specific antigen (PSA) test for prostate cancer detection [5]. This blood test is able to detect prostate cancer at an early stage. However, routine PSA testing is debated. It is unclear whether early detection and treatment lead to significant changes in the cancer trajectory and the patient’s quality of life. The inadequate evidence of benefits for PSA testing hinders support for this screening test, and shines light on some unintentional consequences.

Recognizing the diversity of cancer screening modalities allows us to understand the scope of their influence across the cancer care spectrum. All tests are followed by results, and cancer screening is no exception. The test has either identified cancer in the individual, or it has not. However, there are truly four outcomes:


True Negative The screening test says the patient does not have cancer when they do not truly have cancer
False Positive The screening test says the patient has cancer when they do not truly have it
False Negative The screening test was not able to detect cancer when the patient truly has cancer
True Positive The screening test says the patient has cancer and the patient truly has cancer


In the True Negative scenario (an ideal case as a patient is cancer free), the potential implications from the screening test are procedural and financial. For example, when screening for colorectal cancer through colonoscopy, perforation and bleeding may occur.

For False Positive and Negative results, the screening test was not able to accurately identify the true state of the disease. When screening results appear abnormal even though there is no cancer (False Positive), anxiety may arise and each additional procedure may pose its own risks. For breast cancer, on average, 10% of women will be recalled from each screening examination for follow-up, only 5 of the 100 women recalled will have cancer [6]. In the case of False Negative, medical care is not sought in a timely manner. Treatment may even be delayed if cancerous symptoms are present. Understandably, the severity of the unintended consequences depend on the type and stage of the cancer.

It has been argued that screening may result in unnecessary earlier treatment or over-treatment. For breast cancer, the diagnosis and treatment of cancers that would otherwise never have caused symptoms or death in a woman’s lifetime can expose a woman to immediate risks. These include surgical deformity or toxicity from radiation therapy, hormone therapy, or chemotherapy, and late effects of therapeutic radiation – new cancers, scarring, cardiac toxicity.

Timely screening has proven to be an effective tool in curtailing cancer mortality rates. With early screening and engagement, health professionals are able to better tailor treatment plans to the individual tumor characteristics. Some screening tests and treatments are almost always recommended as the benefits outweigh the risks posed.

In our next article, we will explore the need for tools that facilitate the transition of care following a positive screening (False Positive and True Positive) through diagnostic, workup, and treatment plan. We will also elaborate further on directly engaging oncologists and the care team.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing.