[djsumdog]

There was an Oncologist who was talking about how the number of women coming in for regular exams was non-existent for two months. A few months is enough time for breast cancer to go from stage 1 to stage 2, and for 5 year survival rates to drop by a third[0].

There are going to be a ton of secondary effects due to prematurely closing or clearing out hospitals and clinics, and many people have already died from completely preventable illnesses, with some clinics telling people to not come in when they should have.

[0]: https://unherd.com/thepost/professor-karol-sikora-fear-is-mo...

[jbandela1]

I think this is a very misleading way of looking at it.

For example the US Preventative Task Force evaluates evidence and recommends screening guidelines as well as giving the strength of the evidence.

For breast cancer, the only recommended screening is that women age 50 to 74 have mammograms every 2 years. And that is B grade evidence.

https://www.uspreventiveservicestaskforce.org/uspstf/recomme...

With screenings, you have to be really careful about selection bias. Basically, screening will catch a larger proportion of slow growing cancer. Also with respect to staging, the slower growing a cancer, the earlier the stage you will catch it at.

My guess would be that if you have a cancer that is rapidly going from stage 1 to stage 2, you would already have a worse outcome and the 2 months screening hiatus is not going to be that big a difference maker.

EDIT:

In case people ask about clinical breast exams and self breast exams, here are the American Cancer Society guidelines:

"Research has not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by women themselves (breast self-exams)."

https://www.cancer.org/cancer/breast-cancer/screening-tests-...

So the only guidelines with evidence backing them up call for 2 year screenings. Within that framework, a 2 month delays are not going to be very clinically significant.

[lutorm]

A few months is enough time for breast cancer to go from stage 1 to stage 2 ...

Do women normally have breast exams every few months?

[perl4ever]

I don't understand where you'd get that implication.

Some presumably fairly predictable fraction would have an exam scheduled during the beginning of the epidemic, and a certain fraction of them would have undiagnosed cancer. It seems reasonable to assume significant negative consequences for those people.

[richard_todd]

Presumably some women would have had an exam in February but developed enough cancer to be visible in March, so delaying a couple of months had a huge positive impact on their outcome. How can we measure the net result of all these variables?

[IgorPartola]

The way you measure it is how the GP defined it: percent women who develop early stage breast cancer per month * number of months closed per year.

[jjnoakes]

That only makes sense if a woman gets screened monthly, which they don't.

[IgorPartola]

Think about it this way: you run a clinic that detects 100 cases of early stage breast cancer a month. So you detect a total of 1200 per year, right? Now imagine you close for three months. What happens? Well, 300 of these cases do not get detected during that period. Could they get detected later after you reopen? Sure but by its nature it means that they may not be early stage anymore. Also, some percentage of the women would not reschedule an appointment right away since when the clinic reopens it will be overdue by three months worth of appointments so they might wait much longer to be seen vs the regular schedule, exacerbating the problem.

You are correct that on an individual level it is a game of chance: if you are going to develop breast cancer it’s a bad thing but if by chance you develop it in the right window of time right before your annual exam, your outcome is likely to be better. But from the point of view of screening a large population stopping testing for a period of time is bad.

Think about it in terms of COVID: what would happen if all testing was shut down for a month? No, not everyone who gets COVID would get it in that month but the people who do will absolutely not get tested, right?

[lazyasciiart]

No. It varies by age or location but it'd be once a year at max - unless perhaps you had already had it or for some other reason were extraordinarily high risk.

[lastres0rt]

Exams performed by someone else? About once a year.

A self-exam once a month is one of those "good hygiene" things, though, and might be a decent idea to promote right now while people are getting cagey.