Pink October: Cancer patients yet another casualty of Covid-19

As France marks the start of Pink October – also known as Breast Cancer Awareness Month – doctors and volunteers across the country have sounded the alarm over the dangers of delaying cancer screenings because of the coronavirus pandemic.

A campaign poster for Pink October – also known as Breast Cancer Awareness Month – by the advocacy group RoseUp.
A campaign poster for Pink October – also known as Breast Cancer Awareness Month – by the advocacy group RoseUp. © RoseUp

With the number of coronavirus cases on the rise in France, healthcare professionals are determined to stop another wave of victims: a pink one, or people with cancer.

To this end, doctors and volunteers alike have launched a public awareness campaign for Pink October about the risks of delayed cancer screenings, and the impact it has on patients.

Doctors are especially worried about early testing, a key step in diagnosing a patient. During the lockdown in France, the National Cancer Institute suspended all cancer screenings in an effort to fight against the pandemic. A potentially deadly decision, according to Céline Lis-Raoux, director of the advocacy group RoseUp.

“There was no reason to stop screening, especially in areas where there was little Covid-19. Delaying treatment by even a month can be decisive, if not immediately fatal, with certain forms of aggressive cancer,”  Lis-Raoux told FRANCE 24.

‘Great distress’

Although routine screenings resumed after lockdown ended, many women with cancer symptoms avoided going to a dedicated testing centre or to their gynaecologist’s office.

“There was so much panic and rhetoric by the authorities in the media, that many women were more scared of catching Covid-19 from going out than they were of doing a mammogram,” Lis-Raoux said. “It’s too bad, because breast cancer can be treated quickly and effectively if caught on time. By waiting until next year to get tested, you’re taking the risk of dying from a disease that could otherwise be cured.”

All “non-emergency” surgeries were also put on hold during the first month of lockdown in France. The decision was made in the hopes of freeing up medical and human resources in operating rooms for the fight against the coronavirus. According to a recent study by the Patients Network (Patients en Réseau) organisation, 61 percent of surgeries were cancelled during this period. It was a strategic move that some advocacy groups have since criticised. 

“Many women were deprived of care for several months,” Lis-Raoux said. “This was precious time for the patients, who know that some cancers can metastasize in just a few months.”

Follow-up tests were also pushed back. X-ray and Magnetic Resonance Imaging (MRI) laboratories were forced to temporarily close for reorganisation in accordance with the government’s new public health guidelines. When they eventually re-opened, social distancing meant they could only take a limited number of patients at a time.

“This resulted in more time lost for patients,” Lis-Raoux explained. “Not to mention the psychological impact of waiting! Not knowing how your cancer has progressed for the past six months is an unbearable situation. Our organisation was able to provide psychological support over the phone. Because many breast cancer patients found themselves in great distress.”

A two to five percent increase in mortality

A recent report published by researchers at Gustave-Roussy, Europe’s leading cancer centre, painted a dire picture of the pandemic’s toll on their patients.

“We estimated that delayed care would result in a two percent increase in mortality over the next five years,” the study’s lead researcher, Aurélie Bardet, said in an article published on RoseUp’s website. “In other words, around 5,000 patients will be treated at Gustave-Roussy between now and the end of the year. We know that over the next five years, 2,000 of them will die from their cancer. Among these 2,000 deaths, 50 will be because the pandemic delayed care.”

The results of the study are all the more alarming because it was based on the assumption that patients would return en masse as the pandemic wound down, before a second-wave of coronavirus infections took hold in France this fall.

“We still envisioned a more pessimistic hypothesis in which patients would return later,” Bardet said. “In this new scenario, the death rate increases by 4.6 percent. But it would appear that this scenario is still too optimistic, because not only has the pandemic started again, but we haven’t recovered our normal patient load. This not only means that our diagnosed patients haven’t all come back to continue treatment, but that we haven’t welcomed any new patients who should have been diagnosed since.”

Considering that cancer claims the lives of around 150,000 people – 12,000 of whom are women with breast cancer – each year in France, “a five percent increase in mortality is absolutely enormous,” Lis-Raoux said.

“Especially because this study only concerns patients at Gustave-Roussy, meaning a population that has access to care and is worried about their health. Which is not the case for the whole country,” she added. 

Consequences in four to five years

Yet the situation might not be as bad as it at first appears, according to Paul Cottu, deputy chief of the medical oncology department at the Curie Institute (Institut Curie) in Paris.

“Right now, there’s no evidence to support the hypothesis that Covid-19 will impact breast cancer,” Cottu told the Huffington Post. “The only thing that we can say, is that we can’t say anything. Yes, some patients have postponed their appointments, but, with a few rare exceptions, they have understood that cancer is something serious that needs to be followed.”

“This is a cancer that progresses slowly,” he added, before concluding that it was “not at all certain” that the pandemic would have a “real impact”.

In any case, Cottu argued that it was too soon to truly grasp the consequences for cancer patients. 

“We won’t see the effects of Covid-19 this year, but in four or five years. This is because delayed screening or lack of follow-up care doesn’t necessarily have an immediate impact, but can affect how effective treatments are in the future, changing the long-term survival rate of some patients,” he explained.

In the meantime, people with cancer are four to five times more likely to fall seriously ill from coronavirus, according to the National Cancer Institute. This is because their immune system is compromised by certain treatments, such as chemotherapy, rendering them more vulnerable.

It is not the first time those with cancer have fallen victim to an external crisis. Studies show that the Great Recession of 2007 – which devastated the world economy – had a dramatic impact on cancer screening. This has been attributed to rising unemployment and successive budget cuts in the health sector, leading to an increased death rate of more than 500,000 people worldwide, according to a 2016 article in the British medical journal The Lancet.

This article was adapted from the original in French by Rachel Holman.

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