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Cancer diagnoses dropped sharply in Alberta during COVID-19 response

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Breast-cancer patient Christine Van Deven sits in her backyard with her dog Charlie in London, Ont., on June 9, 2023. Ms. Van Deven wonders what might have happened if her cancer had been caught earlier.Nicole Osborne/The Globe and Mail

Significantly fewer cases of cancer were picked up in Alberta during the first wave of COVID-19 than in the past, according to new research that reinforces other Canadian findings that many patients were denied crucial early diagnoses in the beginning months of the pandemic.

The Canadian Medical Association Journal (CMAJ) study, published Monday, concluded that new diagnoses in Alberta of four types of cancer plunged in the spring of 2020, when much of the health system was shuttered to deal with the new virus.

Diagnoses of melanoma, an aggressive skin cancer, were 43 per cent lower than expected in the province during the first three months of the pandemic. New cases of prostate and colorectal cancer were down by 36 per cent, while breast cancer diagnoses were lower by a third. Some of the biggest drops were in early-stage cancers.

The common factor uniting all four types of cancer is that screening tests such as mammograms, colonoscopies and skin tests can catch them before patients begin feeling seriously ill. Usually, the earlier that cancer is found, the easier it is to treat. But during the first wave of the pandemic, pro-active cancer screening programs were all but shut down across the country.

“This really shows the importance of these cancer screening activities,” said Darren Brenner, a cancer epidemiologist at the University of Calgary and one of the authors of the CMAJ study. “It shows that they are working, because as soon as they go away, even for three months, we see a major drop in early-stage cancer diagnoses.”

The phenomenon of missed or delayed cancer diagnoses during the pandemic has been well-documented in Canada and around the world. Just last month, Statistics Canada reported that cancer incidence was 12.3 per cent lower in 2020 than the average annual rate over the previous five years, after adjustments for the growing and aging population.

The question now is what impact those missed diagnoses will have on cancer survival rates in the future. The new Alberta study found that patients with three types of cancer – colorectal, uterine and non-Hodgkin lymphoma – diagnosed in 2020 had slightly lower one-year survival rates than patients diagnosed with the same diseases in 2018.

However, Dr. Brenner said it was too early to say whether that was a true pandemic effect or a random year-to-year variation. Most other Canadian and international research has found no reduction in short-term cancer survival among those diagnosed in 2020.

In Ontario, researchers at ICES, formerly known as the Institute for Clinical Evaluative Sciences, mined multiple administrative databases to determine that an estimated 16,000 cases of cancer in adults were missed between the start of the pandemic and October, 2021.

But when they compared mortality among patients diagnosed in that period to patients diagnosed in 2018 and 2019, they found no difference in one-year survival rates. When they adjusted for age, sex, prediagnosis health, cancer type and other variables, they discovered that patients diagnosed during the pandemic were slightly more likely to survive, unless they had melanoma.

“This was a surprising result. We’re not seeing a negative pandemic impact,” said Rui Fu, a post-doctoral fellow at the Sunnybrook Research Institute in Toronto. “Just from the statistical analysis … there’s a protective effect of the pandemic on one-year overall survival.”

One possible explanation is that cancer patients who were fortunate enough to be diagnosed during the first 18 months of the pandemic went on to receive treatment and surgery faster because missed diagnoses meant there were fewer oncology patients in the pipeline, according to Dr. Fu.

But she and other cancer trackers agree it will take several more years – at least – to get a clear picture of how the pandemic affected cancer outcomes.

“I would personally expect to see more impact on the survival of the cancer cases that were diagnosed later in 2021 because I think that those are the cancers whose diagnoses were delayed, not the ones diagnosed in 2020,” said Talía Malagón, a cancer epidemiologist at McGill University.

Christine Van Deven, 53, of London, Ont., is one of those cancer patients diagnosed later in the pandemic. She turned 50 – the age at which Ontario recommends all women begin getting regular mammograms – in February, 2020, just as COVID-19 took off.

Ms. Van Deven, a mother of two and the general manager of a retirement home, didn’t get her first mammogram until the summer of 2021, after her doctor found a lump in her right breast. The mammogram found nothing of concern, but Ms. Van Deven’s doctor, still worried about the lump, sent her to a cancer surgeon for a second opinion.

That appointment took place in January, 2022, as the Omicron variant and staff shortages battered the health care system. Delays in MRIs and biopsies added up to Ms. Van Deven not being diagnosed until early May.

By that point, her invasive lobular carcinoma was at Stage 3. She had three tumours in her right breast, one of which was the size of a tennis ball. The cancer had spread to her lymph nodes. She had a double mastectomy, followed by chemotherapy and radiation.

Ms. Van Deven wonders what might have happened if her cancer had been caught earlier.

“I believe it could have been a smaller procedure. I really believe it wouldn’t have gone to my lymph nodes. But I can’t say for sure. I just don’t know,” she said.

 

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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