Assessing Value Versus Risk for Routine Screenings

Should I go to the doctor? This is a recurring question on the minds of those due for routine appointments, screenings, or maybe even a simple check-in. So far, the public has largely heeded warnings to delay routine screenings and move as many consultations as possible to a virtual setting. While these are all valuable behaviors to reduce the spread of COVID-19, there are certain exams that cannot be done virtually, many of which include routine imaging screenings.

Routine screenings for colon, breast, and cervical cancers have dropped between 86 percent-to-94 percent compared to the previous three years, according to medical records software provider, Epic.

Just how important is routine imaging? A few years ago, the 2018 Cancer Facts & Figures Report by the American Cancer Society noted a 39-percent reduction in breast cancer deaths since the 1980s due to earlier detection and diagnosis. Screening with low-dose spiral computed tomography (LDCT) has also been shown to reduce lung cancer mortality by about 20 percent compared to standard chest X-ray among current or former heavy smokers ages 55-to-74. Researchers have also been studying the possibilities of other imaging exams for screenings of traditionally hard-to-treat cancers, such as pancreatic and ovarian cancers.

Over the last few years, recommendations have already become increasingly confusing with The U.S. Preventive Services Task Force (USPSTF) changing standards, including raising the suggested annual mammography age to 50 for women instead of the previously recommended 40. Their concern was that false positives led to unnecessary and often stressful biopsies for women. However, many physicians and radiologists strongly disagree with these recommendations. Over 81 percent of physicians still suggest that routine mammography screenings should begin at age 40.

So, if these imaging exams are so valuable, how long exactly can you wait for routine screenings? The information here is highly muddled. Currently, the American Cancer Society advises that routine screenings should be skipped. They say a delay of one-to-two months is okay for those at average-to-low risk. However, those at high risk due to a family or personal history of cancer should discuss their case with their physician. Some screenings can even be done at home if needed, like colorectal screenings, using an at-home test. Non-imaging related exams like physician, well-woman, and annual skin cancer screening can often be conducted virtually initially and, then, a determination can be made on a date for an in-person visit.

Healthcare technology vendors can help retain imaging value while reducing volume by providing patients with enhanced access to past imaging and allowing them to share data with providers through patient portals, image-enabled EHR portals, and more. The ability for a patient to send and consult with a physician on prior imaging may allow both parties to make a more educated decision on the timing of future exams.

In some cases, certain risk factors might push a physician to encourage someone to stay at home and put off routine exams for longer. Patients should always consult with their own physician on their personal health history and weigh the pros and cons of routine imaging. However, as imaging centers increasingly take new precautions on the safety of their facilities and add new technology that could reduce in-person interaction where possible, healthy patients will likely be able to resume necessary and routine image screening.