New report highlights pandemic hit to screening and diagnosis

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A new report prepared by Bowel Cancer Australia has highlighted the impact the COVID-19 pandemic has had on diagnosing what is Australia’s second deadliest cancer.

The organisation said colonoscopy waitlists existed prior to COVID-19 and have been further compounded by the pandemic.

"Studies show delays increase the risk for bowel cancer progression and mortality," it said, pointing to research published in The Lancet that showed a six-month disruption to screening will result in 1,961 additional deaths in Australia.

A Cancer Australia report showed between January and September 2020, the number of colonoscopies and sigmoidoscopies performed to diagnose bowel cancers fell by 15 per cent or 78,048. In addition, there were 216,537 fewer bowel cancer screening tests returned and 381 fewer bowel cancer surgeries.

Over the past 20 years, bowel cancer incidence rates have decreased more than any other cancer. "These improvements are now at risk," said Bowel Cancer Australia.

The new report, 'COVID-19 and the Impending Bowel Cancer Crisis', highlights examples of solutions that have been implemented to address delays in diagnosis due to colonoscopy backlogs.

Colorectal surgeon Graham Newstead AM said, “Delayed screening leads to a delayed diagnosis. Delayed diagnosis leads to delayed treatment. Delayed treatment leads to poorer outcomes. Put simply, delays can lead to unnecessary deaths and COVID-19 has made the situation even worse.”

Kate was diagnosed with bowel cancer during COVID-19. “In the height of the pandemic, whilst pregnant with my first child, I experienced bowel cancer symptoms. I presented multiple times to a variety of healthcare professionals with various symptoms including blood loss, rectal bleeding, fatigue, constipation, and diarrhoea only to have my symptoms continually dismissed as pregnancy related. On one occasion I can recall I was advised to eat more fibre!” she said.

“As the CEO of Emergency Management Victoria (EMV), I was working extremely long hours on the COVID response, but I knew something wasn’t right. I eventually had a sigmoidoscopy and was diagnosed with stage 2 bowel cancer aged 37 and 5 months pregnant.

“The emotional stress this placed on me and my family was enormous – I was worried about the impact of cancer on our unborn baby, and we were required to consider miscarriage and future fertility. It was a very traumatic time, and I was anxious about the health of our baby in the lead up to her birth in March this year.

“We must not delay if we suspect something is wrong regardless of COVID-19. I want people to be aware that you are never too young for bowel cancer. If you have symptoms, then follow-up with your GP or healthcare professional and trust your instincts. Persist with doctors and ask the questions or seek referrals to specialists as you know your body best.”

In fact, just a four-week delay of cancer treatment is associated with increased mortality.

“Planning for post-pandemic colonoscopy catch-up and increasing ongoing capacity is urgently required as bowel cancer must not be forgotten in the long shadow of COVID-19,” added Associate Professor Newstead.

“Early diagnosis is a key predictor of surviving bowel cancer and positive test results and symptoms need to be investigated via timely colonoscopy. It is imperative we address the colonoscopy waitlists, otherwise we risk undoing the gains made over the past 20 years.”