The Covid-19 pandemic and the botched handling of it have been tragic in many different ways. One of the still emerging tragedies has been delays in the diagnoses of and care for other types of medical conditions because people weren’t being seen in clinics and hospitals as regularly as they should have. That’s probably left a lot of people “shoulding” all over themselves as in should’ve, could’ve, would’ve gotten treatment earlier. For example, a study recently published in BJU International estimated that the “pandemic led to 20,000 missed prostate cancer diagnoses in England alone,” in the words of the study authors.
That’s just England, which has a population of around 56 million, about a fifth of the U.S. population. Now “handled it well” wouldn’t the first words that you may think of when it comes to the U.S., the U.K., and the Covid-19 pandemic. The U.S. has had the most deaths (over 1.18 million) from Covid-19 in the world while the U.K. has had the sixth most (over 233,00). Both countries had leaders claiming that they pandemic was “rounding the corner” or “we can turn the tide” in 2020 when guess what neither happened.
Let’s assume then that the U.S. had a similar rate of missed prostate cancer diagnoses as England did. The 20,000 in England number would mean that potentially well over a hundred thousand men in the two countries have been or will be left wondering, “What if?” What if the U.S. and U.K. had better functioning healthcare systems during the pandemic? What if their prostate cancer had been detected one, two, or three years earlier? What if their disease had been detected before it had spread and potentially become less treatable?
To get the 20,000 number, investigators from the University of Surrey (Agnieszka Lemanska), the University of Oxford (Colm Andrews, Louis Fisher, Seb Bacon, Amir Mehrkar, Peter Inglesby, Simon Davy, Ben Goldacre, Brian MacKenna, and Alex J. Walker) and the OpenSAFELY Collaborative conducted analyzes on the OpenSAFELY-TPP dataset of 24 million patients, which comprised about 40% of England’s population. They graphed the monthly rates of prostate cancer incidence, prevalence, and mortality per 100,000 adult men that were reported from January 2015 through July 2023. Then they used statistical methods to extrapolate what the rates from March 2020 and beyond could have been had the Covid-19 pandemic not occurred.
These analyses showed a lot of should’ve, could’ve, would’ves. The year 2020 saw a 4,772 (31%) drop in the reported incidence of prostate cancer while 2021 saw a 3,148 case drop. The patient’s average age at diagnosis moved up too from 71.3 in 2019 to 71.6 in 2020 and 71.8 in 2021. Adding the 4,772 and the 3,148 case numbers gives you about 8,000. Dividing that by 40% leaves you with around 20,000 cases.
Now it’s not as if some kind of miracle prostate cancer prevention method emerged in 2020. More people wearing denim, tiny glasses, and bucket hats in 2019 probably didn’t help decrease the risk of prostate cancer in ensuing years. Therefore, you wouldn’t have expected the actual incidence of prostate cancer to have dropped in 2020 and 2021. Or the age at which prostate cancer emerged to have risen either. Thus, these changes were probably for the most part due to delays in men getting proper prostate cancer screening such as their prostate-specific antigen (PSA) levels in the blood being checked and their getting digital rectal exams. In the end, this led to a whole lot of missed diagnoses.
The American Cancer Society recommends that men start screening for prostate cancer at age 50 if they have average risk of developing prostate cancer, age 45 if they are at high risk (e.g., African American men or men who have a first-degree relative diagnosed with prostate cancer before age 65) and age 40 if they are at even higher risk (meaning that they have had one first-degree relative diagnosed with prostate cancer before age 65). An elevated PSA, finding a nodule or mass on a prostate/rectal exam or both in many cases should prompt further evaluation such as magnetic resonance imaging (MRI) or biopsy of the prostate or both. Shawn Dason, MD, an Assistant Professor of Urology at The Ohio State University College of Medicine, described how the biopsy will help identify definitively whether there is cancer in the prostate and “how aggressive the prostate cancer is.” Delays in any of those possible steps could in turn delay diagnosis of prostate cancer.
And the timing of diagnosis is key in the treatment of any type of cancer and your odds of survival. Dason described prostate cancer as “treatable” but emphasized that a delay in diagnosis “does increase the chance of it spreading to other parts of the body. This in turn influences treatment.” Spread of the cancer beyond the prostate can significantly reduce your chance of survival and increase the scope and types of treatments that you need. So, unfortunately, a lot of men may now have to deal with worse odds and worse treatment effects.
It would be easy for political and business leaders to blame the severe acute respiratory syndrome coronavirus 2 (SARS-COv-2) and simply say, “No one expected the pandemic.” But the pandemic wasn’t like The Spanish Inquisition in that Monty Python skit. Many people were indeed warning political and business leaders about the threat of a pandemic in the decade preceding the Covid-19 pandemic. For example, in 2017, I wrote for Forbes about how “our society is woefully underprepared for a bad pandemic” and how Bill Gates was warning leaders about the possibility of a pandemic within the next 10 to 15 years. But as the chaos in the pandemic response in 2020 showed, not enough political and business leaders heeded such warnings.
Preparing for the next pandemic when—and not if—it comes should include shoring up the healthcare system so that it can continue to function at full capacity even when a pathogen is spreading all around. This means making sure that all clinics and hospitals have plentiful personal protective equipment (PPE) on hand, the appropriate infection control procedures in place, enough personnel to compensate for surges in demand and telehealth options implemented in a well-organized fashion as opposed to the meerkats-in-a-mosh-pit chaos of 2020 that spilled into subsequent years. Meanwhile, dealing with the Covid-19 pandemic present should include ways to make up for the delays in the care that have occurred and giving thousands upon thousands of patients what they haven’t had: proper healthcare.
