In the latest installment of our occasional conversations with Fort Worth leaders, James Earl II, the director of outreach and health equity at Cancer Care Services in Fort Worth, discusses an incoming cancer tsunami as a consequence of the pandemic, cancers for which early screening is critical and what to expect when it comes to getting screened.  

This conversation has been edited for length and clarity. For the unabridged version, please listen to the audio file attached to this article.

Alexis Allison: How has the pandemic affected cancer care?  

James Earl: Experts in the oncology field talk about how the pandemic has resulted in delays in identifying new cancers and the delivery of treatment. There was actually a statistic from the Prevent Cancer Foundation in 2020 that indicated that almost half of Americans had missed scheduled appointments, and one in three had missed routine cancer screenings.With these delays in screenings, they are predicting what is called a “cancer tsunami.” And the outcome, which we’re going to see over a number of years, will include increased cancer diagnoses, increased late-stage cancer diagnoses, and then ultimately, we’re going to be looking at higher death rates from cancer for years to come.

Allison: Can you tell us a little bit more about a late-stage cancer diagnosis and what that could mean for a patient?

Earl: With a late-stage diagnosis, what we look at is the prospect of the cancer spreading to other vital organs. We call this ‘metastasis.’ When that cancer spreads to other distant parts of the body, it makes the cancer a lot more difficult to treat. When we look at cancers that are diagnosed stage one, stage two, they are in more localized regions. And it makes it a lot easier to treat the cancer diagnosis.

Allison: If people weren’t getting screened, and now they get screened and have cancer, it’s possible they’re at a later stage?

Earl: Yeah, and there are actually three cancers in which early screenings are critical. That is breast, colorectal and prostate cancer. And during the pandemic, there were sharp declines in all three. We’re just exiting out of Breast Cancer Awareness month, but there was like a 90% decline in breast cancer screenings (in April 2020 compared to April the year before).

When to screen for common cancers:

Breast

  • Test: Mammogram
  • Age to start screening: 40-44 for women with average risk; 30 for women with high risk

Colon

  • Test: Colonoscopy, stool tests
  • Age to start screening: 45

Cervical

  • Test: HPV test, Pap test
  • Age to start: 25

Prostate 

  • Test: Digital rectal exam, blood test
  • Age to start screening: 50 for men with average risk; 45 for men with high risk; 40 for men with even higher risk

Allison: What are some of the other cancers that people should be getting regularly screened for besides breast, colorectal and prostate?

Earl: You want to throw in cervical cancer as well. When we look at all of those cancer types, there are recommended screening guidelines. When we start off with breast cancer, for women with an average risk of breast cancer, you really want to start that screening process between 40 and 44. And then, for women who are considered high-risk due to either genetic factors or those who have a family history of breast cancer, typically screening starts at the age of 30. 

For cervical cancer, testing and screening should begin at about the age of 25. And for colon cancer, 45 is typically the starting point for cancer screenings. Prostate, very similar to breast cancer, you really want to look at it in terms of average risk, higher risk and even higher risk. For men with an average risk of prostate cancer, that’s 50 years. For men with higher risk, and these are typically men who are Black, you want to start at around the age of 45. And those with an even higher risk — that is Black men with a family history — screening for prostate cancer begins at 40. 

And then, to round things out, for lung cancer, which is another common cancer type, typically the age is between 50 to 80 years old if you’re fairly good health. Maybe you’ve currently smoked or have quit smoking in the past 15 years and you have at least a 20-pack year smoking history.

Allison: Let’s say someone’s listening and they realize they fall into one of these categories. What could you tell them about what screening actually involves?

Earl: For your common cancer types: Breast cancer, you may undergo a mammogram for screening. There’s also HPV and Pap tests for those that are potentially at risk for cervical cancer. And then, for prostate cancer, we look at the PSA, or prostate-specific antigen blood test, or digital rectal exam for prostate screening, and then for lung cancer screenings, CT scans.

Allison: And are you able to speak to the cost of these screenings if someone’s concerned about money?

Earl: What I really like to emphasize is that there are many ways to go about getting screened. Primarily for those that are insured, the Affordable Care Act requires both private insurers and Medicare to cover the cost of certain cancer screening tests. If you have a plan that was already in place prior to the ACA being passed, it was a plan that was maybe grandfathered in, it might not offer the same type of coverage. It’s important to consider the date your insurance plan was started and if the recommended tests are covered. You can actually contact the insurance company to determine whether a screening test can be covered. 

There are provisions in place for those who may not have insurance or perhaps be underinsured. With the pandemic, the American Rescue Plan Act came into law in April of 2021. This law really addresses many of the financial problems that were caused by the pandemic. And one portion focuses on lowering insurance premiums and improving access to affordable health care coverage. 

Many people lost their jobs during the pandemic. Even if you wanted to get screened, and you were laid off, that really impacted your ability to access this type of service. The law really provides financial support to help with the cost of health care coverage, by allowing people who do not currently have insurance to sign up for a plan that is lower costs through the insurance marketplace. And also, for those who are currently in the marketplace, they may have experienced their premiums being lowered in some way. 

And then, for those who have actually lost their jobs due to the pandemic, they have a provision available to help cover premium costs, if they choose to keep what is called Cobra, which is an employer-sponsored health care plan. So the aid that is provided through the American Rescue Plan Act covers up to 100% of Cobra premium costs. That coverage is something to keep in mind may only be for a certain period of time.

I wanted to highlight organizations like the Moncrief Cancer Institute, Barbara Cares, our local partner in JPS with the Tarrant County Indigent Program and our federally qualified health care centers. They are also resources and services available to those who may be uninsured or underinsured to access screenings.

Allison: Thanks for mentioning those as well. People who want to get screened could possibly contact one of those institutions. Who else could they turn to ask for their screenings? 

Earl: They can also turn to their local healthcare providers, primary care physicians, for those individuals that are insured, to get screened.

Allison: Thank you. And is there anything else that you hope people know, when it comes to cancer care, this ‘cancer tsunami,’ or anything else you’d like to share?

Earl: As a community-based organization, we are really uniquely positioned to be of support along the cancer continuum. Now, the services that we provide at (Cancer Care Services), are really focused on providing emotional, financial and social support after a person has been diagnosed. We really look to partner with those in the community that are in the screening space, so we can really, really bridge the gap in the continuum of care as it relates to cancer. We ultimately want to be of service to all of those impacted by cancer, or who have the potential to be impacted by cancer. 

​​Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here

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