I’m Trying to Balance My Fears of COVID-19 With Returning to Routine Cancer Screenings and Health Care

In the past month, I have joined what feels like an immense crowd of people trying to catch up on routine health care. The pandemic has made me think seriously about cancer, public health and society, and it has forced me to confront (again) how I behave when I feel fear. Just as with cancer and its endless parade of repercussions, the idea of “living with COVID-19” means that I have to figure out what risks I’m willing to take when complete trust is impossible.

It’s here, in this landscape of cancer, fear, risk and lack of total trust, that so many of us are trying to get more complete care.

Other than an oncologist telling me to postpone a colonoscopy because there were more urgent issues — and there were, since I was newly diagnosed and starting my first treatment — I’ve been grateful for my doctors trying to keep me on top of preventive care. My primary care doctor is a crucial person here because she gets authorization for almost everything other than breast and breast cancer care, which is arranged by my oncologist.

The fact is, though, that I continue to try to balance my acceptable level of risk of COVID-19 with the risk of other health problems. Actual risk may be very different from perceived risk, which in my case is strongly impacted by the psychological effects of a de novo stage 4 cancer diagnosis, and now ongoing cancer treatment during a time when people ignore so many risks to others.

In short, it’s been difficult to maintain routine care, but it’s also hard to set aside the many fears we have when it comes to our health. For a person like me, who doesn’t like to think about all the other ways my body could betray me, it’s crucial to stay on top of preventive care so that I don’t fall into the trap of making excuses. If you’ve been holding off on screening and other care, it could be important to get back on schedule.

Mammogram

Though some with metastatic breast cancer don’t continue with mammograms, I do. It can be a first step in seeing a new or local recurrence of cancer, though be sure to talk with your doctor about your specific care. An MRI or ultrasound of the breast may be necessary, for instance, for people with dense breasts or for lobular breast cancer. Inflammatory breast cancer may not show up on a mammogram or ultrasound, but appear as a rash or irritated skin on your breast. In addition, men experiencing changes to their breast tissue should request a mammogram.

PSA and Pap Smear

The prostate specific antigen (PSA) test isn’t recommended for all men and asking your doctor about your individual risk is important. For women, the pap test (or pap smear) is an important tool for detecting cervical cancer before symptoms surface. It is recommended for those under 65 who are sexually active. The human papilloma virus (HPV) is linked to several cancers, including cervical cancer, and your doctor may recommend an HPV screening at the same time as your pap test. Although it can be difficult to associate cancer with these delicate and private subjects, it’s important to be honest with your doctor so that they can make the best possible recommendations.

Colonoscopy

This is the test that got me thinking about how easy it has been to delay standard procedures. But a colonoscopy can catch changes to your body before cancer develops. A screening colonoscopy is recommended for those 50 and over, after which your doctor will tell you about future tests, and earlier for those who have risk factors, such as family history. If a polyp is found, the colonoscopy becomes diagnostic. The polyp will be removed and analyzed by a pathologist, and your doctor will advise about the timing of future tests.

Cholesterol

A test of your cholesterol levels is a blood test, which is much easier than some of the other screening tools. Many people will need to be tested only once or twice a decade. If you have risk factors, such as diabetes, heart disease or a family history of high cholesterol, your doctor may advise for more frequent testing and may prescribe medication.

Diabetes and Prediabetes

Your health care provider will be able to recommend what testing and frequency of testing is appropriate for you. Some doctors recommend that everyone, regardless of weight or other risk factors, be tested starting at age 45.

Dental Care

Regular dental care is important for everyone, and especially for those living with cancer because oral health can affect the health of your body. If you have been putting this off because of COVID-19 fear (or any other fear), consider getting back on track with an appointment to improve oral hygiene.

Just starting the conversation about preventive care is a great first step with your doctors. Know as much as you can about your family history and be straightforward about your behaviors so that your team can help you live well for as long as possible.

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