The worrying impact of COVID on cancer screening and detection

Public Health Association of Australia

While the COVID-19 pandemic has dominated our lives and public health efforts over the past 18 months, there is still a need to be urging Australians not to ignore the other ‘Big C’.

Cancer remains one of the biggest killers in Australia, but with so much focus on staying COVID-safe, cancer screening participation has fallen dramatically across the breast, cervical, and colorectal cancer screening programs, according to an AIHW report comparing participation rates between 2019 and 2020.

It’s a timely reminder as we come to the end of Bowel Cancer Awareness Month of June, Bowel Cancer Australia’s signature event to raise awareness of Australia’s second deadliest cancer.

Bowel cancer claims the lives of 101 Australians every week (5,255 people a year) – but it’s one of the most treatable types of cancer if found early.

While the risk of bowel cancer increases significantly with age, the disease doesn’t discriminate, affecting men and women, young and old. Approximately 293 Australians will be diagnosed with bowel cancer this week (15,206 people a year).

Last year in NSW, there were around 5,250 fewer bowel screening tests returned than in the same period in 2019. And that’s almost certainly resulted in disease diagnosed at a later age and poorer outcomes, and in some cases preventable deaths.

It’s a similar story for other important cancer prevention programs, with nearly 50,000 fewer mammograms completed in NSW between January and June in 2020, and nearly 130,000 fewer cervical screening tests. This, against the worrying backdrop of Australia’s regular high rates of cancer with 150,000 new cases diagnosed in 2019 and just under 50,000 cancer deaths.

At the PHAA’s recent Preventive Health Conference in Perth, delegates learned that tens of thousands of Australians were having greater adverse effects from a cancer diagnosis, some losing their lives unnecessarily each year as a result of later detection or lower screening participation. The situation is only made worse by the COVID-19 outbreak.

Cancer detection programs

Caitlin Vasica, from Cancer Council NSW, told the conference that three preventive national cancer screening programs were having varying levels of success in her home state, and also nationally.

NSW has the second lowest participation rate in the country for the National Bowel Cancer Screening Program. The national target rate for bowel cancer screening is 56.6%. Currently, NSW has 39.3% screening particpation, compared to the national average of 42.4%.

Our research shows we could save almost 84,000 lives nationally over the next 19 years if we could increase participation in the bowel cancer screening to closer to 60%,’ Ms Vasica said.

A high-profile advertising campaign is currently being rolled out nationally, featuring the ABC’s Dr Norman Swan, in the hope of lifting those screening numbers.

Norman Swan holding a bowel cancer home test kit

For the National Cervical Screening Program, the national participation target is 57%. The current rate nationally sits on 54.1%, and NSW sits third lowest in the nation on 51.5%.

In better news, the national participation target for breast screening is 54%, and the latest national numbers (54.3%) narrowly exceed that target. NSW sits second lowest in the nation on 53.4%.

‘It’s clear there’s a lot of work to be done to increase participation rates in these three important programs,’ Ms Vasica said. ‘In the past year, Cancer Council NSW has upskilled 50 staff to support the screening programs.

‘We’re making sure our focus is on those areas in the community of greatest need, and initiatives that will have the most impact. Cancer Council NSW is now targeting hard to reach communities, including participation from Aboriginal and Torres Strait Islanders, culturally and linguistically diverse groups, and identifying new communities of need.’

‘We ensure all our activity and promotion is evidence-based, collaborative, consistent and targeted.’

Alcohol and cancer

The PHAA conference also heard about the health risks from excessive alcohol consumption which is linked to at least seven types of cancer.

Cancer Council Victoria’s, Elizaveta Ilchenko, shared disturbing data collected from a survey of 3,000 Australian adults collected at the start of the COVID pandemic, in February and March 2020.

Respondents were asked to name all the cancers they believed to be caused by consuming alcohol.

‘With the exception of liver cancer, prompted awareness of the link between alcohol and specific cancers was low,’ Ms Ilchenko said. ‘In fact, overall, more alcohol consumers are aware of the link between alcohol and non-cancer health conditions (overweight, heart disease, stroke) compared to specific cancers when unprompted.’

She suggested public communication strategies were needed to raise awareness of the cancer risks associated with the consumption of alcohol.

Since the conference, Cancer Council Victoria has launched a campaign, highlighting the link between alcohol consumption and cancer risk.

Fighting skin cancer

Australia and New Zealand continue to report the highest rates of skin cancers in the world, and Shannon Jones from Cancer Council Victoria told the delegates that GPs play a pivotal role in the early detection and management of skin cancer in Australia, with more than one million patient encounters each year for skin cancer.

‘Australian clinical practice guidelines for the diagnosis and management of melanomas recommend clinicians who perform examinations for skin cancer should be trained in, and use, dermoscopy. But it’s estimated that only between 34%-43% of Australian GPs use dermoscopy,’ Mrs Jones said.

In 2018, an innovative project titled, the Dermoscopy for Victorian General Practice Program was created, to equip and upskill Victorian GPs by providing a fully-funded dermatoscope and training to prevent and detect skin cancers. 76 GP places were offered in 2018, and this was expanded to a further 130 GPs the following year, thanks to philanthropic support.

‘And again, in 2020, 60 additional places were offered, meaning we’ve now trained and equipped more than 250 Victorian GPs from 250 practices,’ Mrs Jones said.

‘The program has targeted GPs working outside metropolitan Melbourne with no, or limited access to a dermatoscope. Participating GPs are required to complete six education modules, case studies, a webinar, and a one-day training workshop. In total, the training includes between 30-50 hours of online and face-to-face education which is guided by a specialist dermatologist.’

A follow up survey found that 71% of GPs reported using their dermatoscope daily or several times a day. GPs said that since participating in the program their referral decisions and quality of patient care had improved either to a large or moderate extent, and they’d increased the preventive information they’d given to patients. GPs also agreed their confidence in diagnosing melanoma had increased.

A recent survey of Victorian GPs about the effect of COVID on skin cancer care showed the vast majority of GPs indicated their delivery of skin cancer prevention and early detection information, as well as skin cancer examinations, had been reduced.

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