Millions of medical appointments and screenings have been cancelled or postponed during the pandemic because facilities closed or patients were too nervous to go to the doctor’s office.
As women start to return to the doctor, we asked Dr. Michelle A. Glasgow of Atlanta Gynecologic Oncology her advice for women on where they should start. What screenings should they get first? And is it safe to even go to the doctor? Read her recommendations below.
What trends have you seen in your own practice during the pandemic?
Over the past year, I have seen that many women have delayed not only undergoing routine screenings, but they have also delayed seeking evaluation for abnormal symptoms, such as new vaginal bleeding after going into menopause or bothersome vulvar itching or pain. These abnormal symptoms often have indicated the presence of a gynecologic cancer, such as uterine cancer or vulvar cancer. As a result, there have been delays in diagnosis of gynecologic cancers, which are now being identified at later stages than usual.
As women start to go back to the doctor, where they should start? What screenings should they get first?
As women start to go back to the doctor, I advise them first to seek evaluation for any abnormal symptoms which they are experiencing, such as a new breast lump, vaginal bleeding after going into menopause, new bloating or constipation, or itching in the labia. These are symptoms which may indicate the presence of a new breast cancer or gynecologic cancer. If a woman is not experiencing any new symptoms, I advise her to make an appointment with her general OB/GYN or primary care provider to determine what age-appropriate cancer screening she is due for next.
What cancer screenings should women get every year?
Routine cancer screening is very important; however, not all screening tests are required yearly.
For instance, pap smears, which are used to screen for cervical cancer, are generally recommended every three years, or every five years if an HPV (human papillomavirus) test is used. This screening test should begin at the age of 21. Pap smears may be required more frequently if your last result was abnormal.
I recommend an annual mammogram for breast cancer screening; however, some leading organizations recommend that women ages 55 years and older who are of average risk can be screened for breast cancer every two years. These organizations don't all agree on when to begin screening mammograms; however, I support screening beginning at age 40 because screening mammograms can detect breast cancer early.
I recommend a colonoscopy every five to 10 years as screening for colon cancer, beginning at age 45. There are also several alternative options for colorectal cancer screening, such as stool tests like the Cologuard® test, which may be performed at home. (If this test is abnormal, however, you will still need to undergo a colonoscopy.)
What advice do you have for patients who are still too nervous to go to the doctor?
It is very safe to undergo cancer screening tests now, as the CDC has recommended various measures for health care facilities in order to reduce the risk of transmission of COVID. Some of these measures include screening patients via telephone to determine if they have any COVID-related symptoms and also scheduling appointments to allow for physical distancing between patients and to avoid crowding in waiting rooms. Screening centers also have protocols for disinfecting and cleaning equipment. Finally, everyone should wear a face mask and there should also be frequent hand washing and use of hand sanitizer. For those who are still too nervous to go to the doctor, I encourage women to call and ask what measures are in place to reduce the risk of COVID transmission.
Anything else you’d like to add?
Since April 2020, there have been significant declines in rates of breast and cervical cancer screening (greater than 80%), and as such there have been delays in diagnosis of common cancers and consequently poorer health outcomes. As there are better protocols in place now to reduce the risk of COVID transmission in health care facilities, I highly recommend women resume appropriate cancer screening as soon as they can.
Dr. Michelle A. Glasgow is board-certified in obstetrics and gynecology and gynecologic oncology. She sees patients at Atlanta Gynecologic Oncology, a Northside network provider, in Canton, Ga.