Thousands of cancer screening tests halted during pandemic restart in Alberta

Many cancer screening procedures put on hold during the pandemic are now resuming as the Alberta government eases coronavirus restrictions.

More than 170,000 tests, including an estimated 40,000 mammograms, were suspended for two months starting at the end of March to allow the health-care system to prepare for an influx of COVID-19 patients.

Last week, community radiology clinics and Alberta Health Services diagnostic imaging services opened up, allowing many mammograms to resume. 

Tests for cervical cancer (including Pap tests and colposcopies) are restarting gradually. Colorectal screening tests are also being phased in, with colonoscopies now being performed and FIT tests (fecal immunochemical tests) expected to resume in June.

A mobile breast cancer screening program run by AHS is also expected to reopen next month.

"We will take a very cautious and phased approach for the resumption of services," said Dr. Huiming Yang, medical director for screening programs with AHS.

According to Yang, patients will be prioritized based on need and who has waited the longest.

"Patients with abnormal screening results before COVID-19 service interruption will be contacted for appropriate followup first and then we will just move down the list."

Thousands overdue for testing

According to AHS, in a two month period an average of 53,000 FIT tests (for colorectal cancer), 58,140 Pap tests (for cervical cancer) and 41,180 mammograms (for breast cancer) would normally be conducted. AHS said approximately 20,000 colonoscopies were rescheduled due to the pandemic.

"Thousands and thousands of people are overdue for cancer screening," said Yang.

"I don't want to cause alarm … because after all, we're dealing with preventative health care. Cancer screening is for people who don't have symptoms. We want to identify the cancer — even pre-cancerous lesions — before symptoms appear so that the treatment will be more effective. A short delay is considered very low risk."

The Alberta Breast Cancer Screening program normally conducts more than 20,000 screening mammograms per month. According to Dr. Robert Davies, president of the Alberta Society of Radiologists, roughly 90 per cent are done in community radiology clinics.

"This is an important service for women to receive and … we're quite concerned about the delay and getting caught up on that work," said Davies.

"Through this program itself, we diagnose approximately 130 breast cancers per month.

'And so with the suspension of screening mammography at the end of March until last week — approximately two months — we're anticipating that 250 cases of breast cancer in Alberta that normally would have been diagnosed over that time period are sitting out there waiting for these women to return for screening so that we can identify these cancers and get on with treating them."

But the backlog will take time to alleviate.

Radiology clinics have to follow health guidelines, including physical distancing, screening patients and the use of personal protective equipment, and can't see as many patients as a result.

Davies' clinic is operating at about 70 to 75 per cent capacity and may have to expand hours to address the backlog.

"No one should panic here.… a few weeks or a month in a delay of diagnosis isn't usually going to have a big effect on the outcome in the end. I think that the issue is more congestion at multiple bottleneck points in the system.

"If you have a rush of diagnoses, these patients need to see a surgeon, they need to see an oncologist and so on. This compression of these cases may result in some bottlenecks."

Davies says it will take a co-ordinated approach by AHS to deal with the backlog and get patients the treatment they need.

"There will be 250 breast cancer cases that we're going to be getting caught up on here in the next month or two and those women are going to need care."