Despite uncertainties due to COVID-19, early detection of bowel caner cannot and should not stop.

During the period March to June 2020, the number of test kits returned was at times lower in 2020 than 2019 according to the AIHW, but wasn’t attributable to the pandemic.

However, colonoscopies and surgeries declined by 57% and 16% respectively.

Early detection and timely access to colonoscopy and treatment largely determines a bowel cancer patient’s long term prognosis and life expectancy.

Delays in diagnosis and treatment can increase the likelihood of metastatic (advanced) disease, however, when detected at the earliest stages, bowel cancer can be successful treated 99% of the time.

If you are experiencing bowel cancer symptoms or have received a positive test result, contact your GP immediately for further investigation.

If you have missed a medical appointment or test, or have new symptoms, now is the time to speak with your GP.

Healthcare services have COVID-safe measures in place to ensure your safety.

Based on anticipated 2020 HPV screening volumes with the new 5-year screening interval, in Victoria we estimate that cervical screening tests are down to approximately one-third of the expected volumes due to the COVID-19 pandemic. Screening test volumes have been very dynamic, and reflect the public health safety measures enacted at different times. For example, there was a steep decline in HPV tests during the first lockdown period with volumes hitting a low in mid-April. We saw a slow recovery during May and June, and then a further, less dramatic, decline with restrictions being tightened again in July and August. We have started to see signs of a slow recovery again in September.

It is important that under-screened groups are not disproportionately impacted by the pandemic. HPV self-collection is a vital tool to help overcome barriers to screening and I encourage GPs to reach out to their underscreened patients to discuss cervical screening.

My message to the community is, if you are at least 30 years old and it has been 4 years or more since your last cervical screening test, ask your GP about HPV self-collection. This involves taking your own sample using a cotton-tipped swab inserted into the vagina. If you live in Melbourne and are in this category, ask your GP whether you might be able to complete the self-collection test at home.

The new AIHW data aligns with the alarming drop in cancer pathology notifications reported by the Victorian Cancer Registry earlier this year.

The impacts of COVID-19 on cancer screening and health checks in Victoria are clear. From April to July, we have already seen a 13 per cent decline in cancer pathology notifications compared to last year. For cervical and breast cancer screening programs, we have seen a greater drop in screening test numbers than the overall national decline.

We’re concerned this may mean cancers are detected later when there may be fewer treatment options available. Victoria’s unique COVID-19 experience means that we may face a slower road to recovery than other jurisdictions.

We encourage all Victorians to prioritise health checks and cancer screening. Attending medical appointments is one of the permitted reasons to leave home and travel outside the 5km boundary, so it’s possible to see your doctor with any health concerns. Health services have implemented infection control and health professionals are doing all they can to make sure it is safe to attend appointments, either in person or via telehealth.

It is important that individuals have their screening tests when they are due (unless of course they symptomatic, isolating or quarantining for COVID – 19), whether they be for breast screening, cervix or bowel screening.

Clearly anyone symptomatic needs to see their doctor and not put off such visits.

The Australian Institute of Health and Welfare (AIWH) have provided statistical data for numbers of individuals engaging with cancer screening programs between January and June 2020 and possible effect of SARS-CoV-2 on this process. Data indicates a decline for individuals presenting for Breast Screen and cervical cancer screening and a more mixed response for screening Bowel cancer during this period. One may suspect the initial decline was due to individuals being concerned of contracting COVID-19 infection by participating in these screening programs. 

Breast Screen suspended services between late March to late April/early May which caused an obvious decrease in women making appointments with Breast Screen. This was subsequently followed by the establishment of precautionary measures to prevent SARS-CoV-2 transmission and protect both health care workers (HCW) and women having mammograms. The requirement for close contact between HCW and clients may have also caused a decline as tighter pandemic restrictions came into effect for some regions.

AIWH has indicated that a change to screening for cervical screening from 2 years to 5 years has taken place, which may reduce the overall number of individuals visiting their general practitioner for a pap smear. Bowel cancer screening is performed using a kit from home and while some fluctuation existed for the number of kits sent via the mail and variations in mail services, no direct effect appears to be evident.

Students studying health sciences at ACU still comment on increasing incidence from a slightly older set of statistics from Breast Screen used in my lectures. A case of “If you don’t look, you don’t find”. The more important observation from the data is mortality (women dying from breast cancer) was decreased, demonstrating the importance of the Breast Screen program in saving lives.

Uncertainty of the risk associated with contracting SARS-CoV-2 and available information to make an informed decision certainly has had an impact on Breast Screen services. Reassurances subsequently provided by health care specialists no doubt eased concerns of the public and individuals, particularly those most at risk, to return to screening programs. 

Cancer screening programs facilitate early intervention that saves lives. We do not wish to see tombstones that read 'Escaped COVID-19 but died from cancer'.

COVID-19 has not changed the fact that one in three men and one in four women in Victoria will be diagnosed with cancer by the age of 75. Cancer health care professionals are extremely concerned about the reduction in screening rates and pathology notifications for cancer. The consequences of people delaying health checks could be profound for both the individual and our health care system. 

We are unfortunately preparing for a wave of cancer cases coming through in the next six to twelve months, so we want to urge Australians that getting timely checks and having follow up appointments is very important, safe and accessible.

This report provides preliminary data on the number of Australians that have attended National Cancer Screening Programs in the first half of this year. The COVID-19 epidemic clearly disrupted the Breast Cancer Screening Program – approximately 150,000 fewer mammograms were performed in the first six months of the year, compared to the same period in previous years. The program was suspended from late March to early May and attendance at the end of June was still well below average for that time of year.

It is not clear whether COVID-19 had an impact on participation in the National Cervical Screening Program as the data are more difficult to interpret because the program is currently transitioning from testing every two years, to testing every five years.

It appears that COVID-19 did not have a major impact on the Bowel Cancer Screening Program, which is conducted via post – kits are sent out and completed kits are returned by mail. Any strategies to catch up cancer screenings should focus on increasing the participation of populations who are under-screened, particularly Aboriginal and Torres Strait Islanders, as cancers detected via screening are generally caught early, and have a better prognosis.

AIHW findings with respect to eligible Australians’ participation in the national cancer screening programs (screening for breast cancer by mammography, screening for cervical cancer by testing for HPV infection of the cervix and screening for bowel cancer by testing for blood in faeces) since the COVID-19 outbreak began are not at all surprising. Australians have done very well in reducing their risk of acquiring COVID-19 by keeping away from people other than immediate family and friends and, with specific relevance to preventive health care such as cancer screening, keeping away from health services by not seeking, other than immediately important, health care.

However, now that COVID-19 has been effectively suppressed in most Australian states and territories, those who have postponed attendance for scheduled mammography or for cervical screening (formerly called a Pap Test) should make an appointment with BreastScreen to have a mammogram or with their doctor to have a Pap Test as soon as they can. Meanwhile, the short delay in having these tests as scheduled will cause little harm. For those who have neglected using the bowel screening kit sent to them, get on with it now. It is likely to do more good than the harm that being unable to have a scheduled mammogram or Pap Test would have done.