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Doctors urge the resumption of preventive care that was stopped during COVID


As the U.S. continues to see declines in COVID cases and hospitalizations, new mask guidance is expected soon from the CDC, perhaps this week. And nearly two years into the pandemic - why it's so important to start thinking about preventative health care again, everything from annual physicals to cancer screenings. NPR's Allison Aubrey joins us to talk about all of this. Hey, Allison.

ALLISON AUBREY, BYLINE: Good morning, Leila.

FADEL: Good morning. So the CDC just recently advised people to wear N95 masks. Now they're considering loosening or lifting mask recommendations. What's the - what's changed?

AUBREY: Well, cases are way down. I mean, there's been about a 70% decline since the start of February. And perhaps even more importantly, the number of people hospitalized with COVID is down, too - about 40%. CDC Director Rochelle Walensky says this is a key metric. So as these trends continue to move, hopefully in the right direction, the agency is reevaluating.


ROCHELLE WALENSKY: We want to give people a break from things like mask-wearing when these metrics are better and then have the ability to reach for them again should things worsen.

AUBREY: Now, many states and cities have already lifted masking requirements, but I think the seed that's being planted here by the CDC, Leila, is that COVID is not being eradicated, so masking could come back if there's another outbreak.

FADEL: What about lifting mask mandates in schools? I mean, this is a real contentious issue at many school districts.

AUBREY: That's right. Dr. Walensky has said for now, the CDC is sticking with the recommendation to keep masks on in schools, though some states have already lifted or set dates to lift requirements. And there really are differing opinions among infectious disease experts about this. Some say there's not much benefit of kids masking if the wider community is not, especially if kids are not wearing high-quality masks. Others say, you know, with many kids still unvaccinated, keep the masks on for now, given that the virus is still circulating. In California, where they're still masking in schools, officials say they will reevaluate their masking policy at the end of this month.

FADEL: Allison, with all the focus on COVID for the last two years, many people have fallen out of the habit of getting preventative health care, or they've been afraid to go to the hospital - everything from cholesterol checks to cancer screenings. And there's new data showing the impact of this delayed care, right?

AUBREY: That's right. The pandemic has had a pretty chilling effect on prevention measures, such as cancer screenings. Take mammograms - fewer women have had them, and now when breast cancers are detected, they're more likely to be detected at a later stage. A new study from UC San Diego found that prior to the pandemic, about 64% of breast cancer patients were diagnosed at Stage 1, but that dropped down to only about half - 51%. The author of the study, Dr. Kathryn Gold, told me she was surprised to see so many cancers diagnosed at later stages.

KATHRYN GOLD: I think really the magnitude of this difference surprised me. I thought we'd see maybe some minor changes year over year, but these were - these are pretty significant.

AUBREY: And it puts the women at risk of worse outcomes, Leila. Before the pandemic, there was a lot of questioning about whether there's too much cancer screening in the U.S. Now, I think, there's a renewed recognition of just how important it is.

FADEL: Now, this study was in Southern California. Is the effect of later cancer detection being seen nationwide?

AUBREY: Well, less screening has certainly been seen nationwide. I spoke to Dr. Connie Lehman. She's Director of Breast Imaging at Massachusetts General Hospital. She said they've seen the same trends - both delays in mammograms and finding cancers at later stages - which she says is very concerning.

CONNIE LEHMAN: The very good news about breast cancer is when we detect it early, we cure it, which is - that's why we have so many women that are breast cancer survivors. However, when we diagnose breast cancer late, it's a very different story. The treatment is much more aggressive. And, unfortunately, the percentage of women that will die goes up dramatically when the disease is diagnosed at a late stage.

AUBREY: So all of these experts say if you are due for a mammogram, go ahead and schedule it. Mammograms typically start at about age 40. The American Cancer Society recommends annual screenings for women from age 45 through mid-50s, then the option of every other year for older women.

FADEL: What about other cancers beyond breast cancer? Has the pandemic led to the same problem?

AUBREY: Yes. One of the largest studies, using a huge medical record database, found a decline in screenings for four cancers - colon, lung, prostate, bladder. For instance, compared to pre-pandemic levels, colonoscopies, the key way to detect colon cancer, dropped off by 45% initially. Now, this has come back some, but it has meant fewer diagnoses. When I spoke to the author, Dr. Brajesh Lal at the University of Maryland who continues to track this, he said unfortunately, the trend pretty much continues. He worries that many people have kind of fallen out of the habit of getting routine preventive care.

BRAJESH LAL: Once that pattern sets in in a 60-, 70-, 80-year-old person, it becomes very difficult to try and bring them back into the routine. And I think that in terms of cancers, we're going to pay a heavy price.

AUBREY: And he says this pandemic effect could be felt for years.

FADEL: OK, so what are doctors doing to try to nudge patients to get back in the habit of screening themselves?

AUBREY: Well, Dr. Lehman told me that one way is just to do more outreach, particularly to high-risk patients. And Massachusetts General has also done something very new. They've streamlined their process. Instead of waiting for days to find out the results of a mammogram, which can be nerve-wracking, they can now do it much faster.

LEHMAN: One thing that we did was we started to offer the results of the screening mammogram while the patient waited. And if a biopsy was needed, we would do everything we could to offer it that day to avoid the back-and-forth of visits and of, you know, needing once again to find child care, transportation or time off from work. And these kinds of programs are good for everyone.

AUBREY: The idea is to make this a permanent change because it's a better way to offer care - just making it more convenient.

FADEL: NPR's Allison Aubrey. Thank you so much, Allison.

AUBREY: Thank you, Leila.

(SOUNDBITE OF TOM DOOLIE'S "EPOCH") Transcript provided by NPR, Copyright NPR.

Leila Fadel is a national correspondent for NPR based in Los Angeles, covering issues of culture, diversity, and race.
Allison Aubrey is a correspondent for NPR News, where her stories can be heard on Morning Edition and All Things Considered. She's also a contributor to the PBS NewsHour and is one of the hosts of NPR's Life Kit.