The significance of cancer screening is undeniable. With routine testing, there is an increased chance of detecting cancer early when it is most treatable. Not only can screening identify cancer at its earliest stages, it can also find abnormalities before they become malignant.

Due to COVID-19, access to potentially lifesaving tests have been reduced. In the beginning of the pandemic, many patients throughout the United States were challenged with the decision to risk exposure to the novel coronavirus, or delay their medical care. At the same time, some cancer screening centers were closed. Updated guidelines suggested to postpone certain procedures to reduce the possibility of infection. States issued stay-at-home orders and across the country there was apprehension to enter medical facilities. These influences led to a sharp decline in cancer screenings. According to one study, at the beginning of the pandemic, breast, colon, lung and prostate cancer screenings decreased by 85%, 75%, 56% and 74% respectively, compared to the previous year.1

To many professionals in oncology, this trend was alarming. Without screening, new cancers may not be detected and treatment may be deferred. This disruption could lead to cancer being diagnosed at an advanced stage and the need for more complex medical care. Consequent negative impacts and adverse outcomes could result for years to come.1

Being aware of the effect of COVID-19 allows for the opportunity to help people overcome existing uncertainties. We can provide education on the importance of screening, and how to do so safely. Using guidance from the Centers for Disease Control and Prevention (CDC), we can equip patients with the tools they need to return to the doctor’s office confidently. This direction includes protective measures taken in a public health clinical setting to ensure risk of exposure is minimized.2 Patients will understand how to protect themselves, while feeling their doctors are prioritizing their well-being.

Health care professionals should consider how cultural and environmental conditions contribute to access to screening. Understanding barriers to care is crucial to efficiently empower patients. Social determinants of health, including race, ethnicity, education, insurance status, employment and location all shape a patient’s ability to get screened for cancer. Although these factors have been present pre-pandemic, COVID-19 has highlighted and often accentuated the fact that these inequalities exist.3

Overall, the COVID-19 pandemic disproportionally affected medically underserved populations, including communities of color.3It has been previously established that there are racial disparities in cancer screening for Black and African American patients, as well as Hispanic patients. During the pandemic, access to cancer screening dropped at higher rates within these populations. Existing fears or mistrust of doctors were compounded by new ones related to COVID-19. Lack of access to care was exacerbated by COVID-19-related changes to public transportation, work schedules or the loss of employment and insurance within these groups.3 If these health disparities are ignored, it is impossible to create comprehensive solutions for cancer screening.

Although there has been improvement in cancer screenings since the beginning of the pandemic, it is our responsibility to make substantial attempts to address gaps to care. To maintain the momentum of recovery, inequities have to be acknowledged. Health care professionals should recognize disparities and contribute to efforts that expand access. There is a necessity to implement outreach, continue campaigns and offer education—especially for vulnerable communities. These initiatives are crucial in getting resources to underserved areas.4 Furthermore, to be successful, programs must be done in a culturally and linguistically appropriate manner.

Time to Screen is an example of a national campaign encouraging people to take control of their health by getting recommended cancer screenings back on track. This collaboration between Cancer

 and the Community Oncology Alliance stresses the importance of screening, educates the public on getting screened safely and provides guidance on getting connected to care. Delivering this service through a health disparities lens, patients will learn how to overcome barriers and obtain their screening. Through these continued efforts, we will be able to make positive impacts and ensure equitable resources to individuals in need. 

For more information on Time to Screen, you can call 1-855-53-SCREEN or go to 

Marissa Fors is Director of Specialized Programs at CancerCare.

 is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include case management, counseling and support groups over the phone, online and in-person, educational workshops, publications and financial and co-payment assistance. All Cancer

 services are provided by master’s-prepared oncology social workers and world-leading cancer experts.

Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. 

. 2020; 4:1059-1071. doi:10.1200/CCI.20.00134

Public Health Activity Guidance.Centers for Disease Control and Prevention.April 8, 2020. Accessed December 15, 202. https://bit.ly/3Fs1nPW

Carethers M, Sengupta R, Blakey R, Ribas A, D’Souza G. Disparities in cancer prevention in the COVID-19 era.

. November 1 2020; 13 (11) 893-896; doi: 10.1158/1940-6207.CAPR-20-0447

Marabella C. Cancer screenings recover from height of COVID-19 pandemic, but disparities remain. OncLive. August 19, 2021. Accessed December 15, 2021. 

Articles

Early detection is key to improving prognosis and achieving better outcomes for patients. 

Addressing the Impact of COVID-19 and Health Disparities on Cancer Screening

Breast cancer is often perceived as a woman's disease, as most breast cancers that are diagnosed in the U.S. are in women. Diagnoses in men contribute to less than 1% of cases.

 Although male breast cancer is rare, health care providers must be well-informed of the psychosocial impacts of the disease. An understanding of the physical and emotional effects specific to men is crucial in the development of patient-centered cancer care.

Men with breast cancer often face unique challenges. This diagnosis can be shocking, and may bring about feelings of isolation, shame, and emasculation. A lack of awareness of male breast cancer, along with responses from others, contribute to these emotions. As health care providers, actions can be taken to better understand the experiences of male breast cancer patients and ensure an inclusive and supportive environment.

It is important to identify the factors that reinforce these feelings of distress. Stigma is commonly expressed as one of the most stressful barriers to receiving care and support for men with breast cancer. This stigma can be experienced in many settings, including within the cancer care system and in existing social surroundings. Studies have shown that breast cancer care focuses on female patients, leading men to feel dismissed. Men report being mistakenly called by female names and prefixes in waiting rooms and will most often be the only male breast cancer patient in the room. This brings about feelings of embarrassment and of being an outsider.

In social settings, men often hesitate to disclose their diagnosis due to fear of how others will react. Many times, close family and friends are the only trusted sources of emotional support, and these chosen few are often equally as shocked by the diagnosis as the patient. Other times, people do not know how to deal with the diagnosis and will retreat from the patient. Men will often feel isolated and have few outlets for support, which leads to social exclusion and ongoing shame.

There are many studies that demonstrate the emotional impact of mastectomy and treatment side effects. However, body image is often a topic reserved for supporting women. Not enough research is designed to understand the effects of scars and altered appearances in men after this surgery. Men may associate their own bodies with a masculine identity. A diagnosis of breast cancer, in combination with visible scarring to the chest area, may contribute to feelings of emasculation and psychological trauma. Additionally, hair loss is not equally addressed. For men and women alike, hair loss contributes to an identity of being sick. Both may express stress due to this side effect of treatment, but in different ways. For example, men may lose facial hair, a typical masculine trait, while in chemotherapy treatments. This could further exacerbate any feelings of emasculation.

These negative perceptions of body image and personal appearance could cause distress for many patients.

In order to reduce the impact of these stressful events, studies have shown there are solutions to provide a more comprehensive approach in the health care setting. More awareness and equality of cancer care will decrease shock and shame. When breast cancer is not seen as only a woman’s disease, negative outlooks decrease. Publications handed to patients could be gender-neutral or contain aspects for both genders.

Discussions about treatment side effects, the impacts on quality of life and concerns about body image that are specific to men will promote an inclusive environment.

 Health care providers play a significant role in the patient’s perception of the disease. Knowledge, attitude, and office atmosphere contribute to better psychological outcomes.

Stigma, feelings of exclusion, and other stressors will impact overall well-being and functioning. Health care providers who can identify these factors will better be able to provide much-needed emotional support, improve quality of care and provide resources tailored to their patients’ needs.

In addition to a well-informed health care team, men with breast cancer would benefit from professional counseling and peer support. Support groups have long demonstrated improvements in quality of life to those with breast cancer, and that remains true for male breast cancer patients. In one study, most men agreed they would benefit from speaking with another man diagnosed with breast cancer.

 Providers who conduct distress screenings and share referrals to resources will have a significant impact on their patients, while meeting their various psychosocial needs.

Even though male breast cancer is rare, all providers can remain conscientious and promote awareness in their practice. Together, we can collectively aim to reduce experiences of stigma and shame and decrease feelings of isolation and fear. Overall, this will have positive effects for male breast cancer patients and generate the respect and support all patients deserve.

Breast Cancer Facts and Figures 2019-2020. 

https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf

Midding W, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a woman’s disease: stigmatization of male breast cancer patients—a mixed methods analysis

2018:12(6) 2194—2207. doi:10.1177/1557988318799025

Robinson JD, Metoyer KP Jr, Bhayani N. Breast cancer in men: a need for psychological intervention. 

Journal of Clinical Psychology in Medical Settings

. 2008:15(2):134-139. doi: 10.1007/s10880-008-9106-y

Ernst J, Mehnert A, Dietz A, Hornemann B, Esser P. Psychological distress in men with breast cancer. 

2006:24(1):95-101. doi: 10.1200/JCO.2006.10.064

Williams BG, Iredale R, Brain K, France E, Barrett-Lee P, Gray J. Experiences of men with breast cancer: an exploratory focus group study. 

89(10):1834-1836. doi: 10.1038/sj.bjc.6601305 

Health care providers play a significant role in the patient’s perception of the disease. Knowledge, attitude, and office atmosphere contribute to better psychological outcomes.

Marissa Fors LCSW, OSW-C, C-ASWCM, CCM

Articles

Addressing the Impact of COVID-19 and Health Disparities on Cancer Screening

Identifying the Needs of Men With Breast Cancer