Oncological pathologies are those that at the same time have suffered to a lesser and greater extent the effects of the stop to postponable services decided by the Ministry of Health. On the one hand, in fact, there are chemotherapies, which are the ones that have suffered the least from suspension. This also applies to follow-up visits for cancer patients. On the other hand, there is prevention, i.e. oncological screening for breast and colorectal cancer, which instead saw a significant reduction in the number of visits performed. A circumstance that, according to an aforementioned study published in Lancet in July 2020, could result in an increase in deaths from breast cancer 5 years after diagnosis of between 7.9 and 9.6% and in an increase in deaths for colorectal cancer, always 5 years after diagnosis, between 5.8 and 6%.
The graph relates the percentage of chemotherapies and cancer follow-up visits postponed in the period between March 1st and April 30th, 2020, surveyed by Pazienti dimenticati, and the incidence of infections per 100 thousand inhabitants, calculated on the total number of cases. recorded in the period considered starting from Protezione civile’s data. Generally speaking, the lower a point is, the higher the percentage of postponed operations, the further it is to the right, the greater the incidence of infections. The points in pink are those for which the percentage is calculated on actual postponements, those in gray are those for which the calculation was made on the basis of the interventions carried out in the same period of 2019.
Even in pandemic hardest hit areas, such as the province of Cremona (the three points furthest to the right on the graph), the reduction in chemotherapy sessions was limited. There are even local health districts that have seen an increase compared to the same period of the previous year. And after all, elective oncological hospitalizations were among the activities that the Ministry oh Health defined as not postponable on its March 16 document. The effect of the suspension, as mentioned, risks being felt in the medium term. The issue concerns prevention:
“Stopping screening will result in an increase in late diagnoses. The tumor progresses and if the diagnosis is not made at stage 1, but in subsequent ones, the chance of recovery is reduced”, explains Lucia Del Mastro, associate professor of Oncology at the University of Genoa and Director of the Breast Unit of the San Martino Polyclinic also in Genoa. Obviously, it is not the same for every tumor. As for breast cancer, “we have less aggressive subtypes, which represent 70% of cases, and for which a 4 to 5 months diagnostic delay has little impact. There are instead biologically very aggressive subtypes, such as the triple negative in which up to 99% of cells reproduce, in which a delay in diagnosis results in significant tumor growth”. And potentially even in a more ominous diagnosis. Today, it is difficult to assess the long-term effects: “we will see them over time. What we see today is a greater number of diagnoses at a more advanced stage than in the previous year”.
An investigation by Riccardo Saporiti, realized thanks to a scolarship granted by SISSA, funded by Paolo Giordano.
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