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More Canadians could face late-stage cancer tied to diagnosis delays during COVID pandemic – CBC News

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It all started with a stomach bug.

That’s what Cheryl-Anne Labrador-Summers thought, anyway. It was October 2020, not long after she’d moved to the tranquil lakeside Ontario community of Georgina, and instead of relaxing with her family like she’d planned, the mother of three was struggling to figure out why she kept experiencing strange, unexplained stomach cramps.

Labrador-Summers tried to visit her family physician, but the office was shuttered because of the COVID-19 pandemic. So she searched for another clinic — only to be offered a phone appointment rather than an in-person assessment. She wound up being told that her grumbling digestive system was likely caused by a mild gastrointestinal illness.

By January, the 58-year-old had a distended stomach, looking — in her own words — “about nine months pregnant.” Again, she reached out to a physician, went for some tests, then headed to the nearest emergency department.

After finally seeing a doctor face to face for the first time in months, she learned the real cause of her discomfort: an intestinal blockage caused by cancer.

“It ended up being a nine-centimetre tumour, and it had completely blocked off my lower bowel,” she said.

An emergency surgery left Labrador-Summers with 55 staples along her torso and a months-long recovery before she could begin oral chemotherapy. Her question now is unanswerable but painful to consider: Could that ordeal have been prevented, or at least minimized, by an earlier diagnosis?

“Had I maybe been able to see the doctors earlier, I would not be in Stage 3,” she said. “I might have been a Stage 2.”

Photos show Labrador-Summers with a distended stomach before her emergency surgery, left, and the 55 staples along her torso following the procedure. (Supplied by Cheryl-Anne Labrador-Summers)

951,000 fewer cancer screenings in Ontario

More Canadians could experience late-stage cancer diagnoses in the years ahead, medical experts warn, forecasting a looming crisis tied to the ongoing COVID-19 pandemic. 

“We expect to see more advanced stages of presentation over the next couple of years, as well as impacts on cancer treatments,” said oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen’s University in Kingston, Ont.

“We know that time is of the essence for people with cancer. And when people are waiting for a diagnosis or for treatment, this has been associated with increased risks of advanced stage and worse survival.”

One review of Ontario’s breast, lung, colon, and cervical cancer screening programs showed that in 2020 there were 41 per cent — or more than 951,000 — fewer screening tests conducted compared with the year before.

Screening volumes rebounded after May 2020, but were still 20 per cent lower compared to pre-pandemic levels.

WATCH | Late-stage cancer being diagnosed in Canadian ERs:

ERs faced with late-stage cancer diagnoses amid pandemic

4 days ago

Duration 2:11

Hospital emergency rooms are seeing a wave of patients being diagnosed with late-stage cancer after the COVID-19 pandemic forced many doctors’ offices to close or pivot to virtual appointments, leading to fewer cancer screenings.

That drop in screenings translates into fewer invasive cancer diagnoses, including roughly 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, an assistant professor in the department of family medicine at the University of Ottawa, in a May commentary piece for the journal Canadian Family Physician.

“The impact of COVID-19 on cancer is far-reaching: screening backlogs, delayed workup of symptomatic patients and abnormal screening results, and delays in cancer treatment and research, all exacerbated by patient apprehension to be seen in person,” she wrote.

“It is clear that there is not only a lost cohort of screened patients but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment,” leading to those cancers being diagnosed at a more advanced stage. 

Tough accessing care in a ‘timely way’

The slowdown in colonoscopies may already be leading to more serious cases of colorectal cancer in Ontario, for instance, suggests a paper published in the Journal of the Canadian Association of Gastroenterology.

“Patients who were treated after the COVID-19 pandemic began were significantly more likely to present emergently to hospital. This means that they were more likely to present with bowel perforation, or severe bowel obstruction, requiring immediate life-saving surgery,” said the study’s lead author, Dr. Catherine Forse, in a call with CBC News.

“In addition, we found that patients were more likely to have large tumours.”

Dr. Lisa Salamon, an emergency room physician with the Scarborough Health Network, is pictured outside Birchmount Hospital, in Scarborough, Ont. (Evan Mitsui/CBC)

In some cases — like Labrador-Summers’s situation — Canadians learned alarming news about their health in hospital emergency departments after struggling to receive in-patient care through other avenues.

Shuttered family physician offices, a shift to telemedicine, and some patients’ fears surrounding COVID-19 may all have played a role.

“It became harder for patients to access care and to access it in a timely way,” Hanna said.

“At the same time, there were real risks — and there are real risks for leaving home to go anywhere, particularly to go to an outpatient clinic or a hospital in order to get checked out.”

Dr. Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she’s now diagnosing more patients with serious cancers, including several just in the last few months.

“So previously, it may have been localized or something small, but now we’re actually seeing metastatic cancer that we’re diagnosing,” she explained.

Lessons for future pandemics

Health policy expert Laura Greer is dealing with Stage four, metastatic breast cancer herself after waiting more than five months for a routine mammogram she was initially due for in the spring of 2021 — a precautionary measure given that her mother had breast cancer as well.

Unlike an early-stage diagnosis, Greer’s cancer is only treatable, not curable.

“It was an example of what happens when you don’t have the regular screening, or those wellness visits,” said the Toronto resident and mother of two. 

“I most likely would have had earlier-stage cancer if it had been sooner.”

Health policy expert Laura Greer is dealing with Stage 4, metastatic breast cancer after waiting more than five months for a routine mammogram she was due for in the spring of 2021. (Esteban Cuevas/CBC News)

Pausing access to care and screenings for other health conditions can have dire impacts on patients, according to Greer, offering lessons for how policy-makers tackle future pandemics.

“We need to make sure that we’ve got enough capacity in our health system to be able to flex, and that’s what we really didn’t have going into this,” she said.

For Labrador-Summers, it’s hard to forget the moment her life changed while she was alone in an emergency department, learning a terrifying diagnosis from a physician she’d just met. Her mind raced with questions about the future and concerns for her family.

Labrador-Summers’s husband and one of her sons kiss her on the dock near their lakeside home in Georgina, Ont. (Ousama Farag/CBC News)

“My older son had just told us they were expecting a child, and I just wanted to be there for them. And I didn’t know what next steps were. And we had lost my mom to cancer a few years back — to us, cancer was always terminal,” she recalled.

“So again, I’m alone, trying to process all of this.”

A screening following Labrador-Summers’ surgery and chemotherapy treatment wound up finding more cancer. 

“It’s now life-threatening,” she said.

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A Logarithmic Map of the Entire Observable Universe – Visual Capitalist

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Logarithmic map of the Observable Universe

For a full-size option or to inquire about posters, please visit Pablo Carlos Budassi’s website.

A Logarithmic Map of the Entire Observable Universe

Among the scientific community, it’s widely believed that so far humans have only discovered about 5% of the universe.

Yet, despite knowing about just a fraction of what’s out there, we’ve still managed to discover galaxies billions of light-years away from Earth.

This graphic by Pablo Carlos Budassi provides a logarithmic map of the entire known universe, using data by researchers at Princeton University and updated as of May 2022.

How Does the Map Work?

Before diving in, it’s worth touching on a few key details about the map.

First off, it’s important to note that the celestial objects shown on this map are not shown to scale. If it was made to scale with sizes relative to how we see them from Earth, nearly all of the objects would be miniscule dots (except the Moon, the Sun, and some nebulae and galaxies).

Secondly, each object’s distance from the Earth is measured on a logarithmic scale, which increases exponentially, in order to fit in all the data.

Within our Solar System, the map’s scale spans astronomical units (AU), roughly the distance from the Earth to the Sun. Beyond, it grows to measure millions of parsecs, with each one of those equal to 3.26 light-years, or 206,000 AU.

Exploring the Map

The map highlights a number of different celestial objects, including:

  • The Solar System
  • Comets and asteroids
  • Star systems and clusters
  • Nebulae
  • Galaxies, including the Milky Way
  • Galaxy clusters
  • Cosmic microwave background—radiation leftover from the Big Bang

Featured are some recently discovered objects, such as the most distant known galaxy to date, HD1. Scientists believe this newly-discovered galaxy was formed just ​​330 million years after the Big Bang, or roughly 8.4 billion years before Earth.

It also highlights some newly deployed spacecraft, including the James Webb Space Telescope (JWST), which is NASA’s latest infrared telescope, and the Tiangong Space Station, which was made by China and launched in April 2021.

Why is it called the “Observable” Universe?

Humanity has been interested in space for thousands of years, and many scientists and researchers have dedicated their lives to furthering our collective knowledge about space and the universe.

Most people are familiar with Albert Einstein and his theory of relativity, which became a cornerstone of both physics and astronomy. Another well-known scientist was Edwin Hubble, whose findings of galaxies moving away from Earth is considered to be the first observation of the universe expanding.

But the massive logarithmic map above, and any observations from Earth or probes in space, are limited in nature. The universe is currently dated to be around 13.8 billion years old, and nothing in the universe can travel faster than the speed of light.

When accounting for the expansion of the universe and observed objects moving away from us, that means that the farthest we can “see” is currently calculated at around 47.7 billion light-years. And since light takes time to travel, much of what we’re observing actually happened many millions of years ago.

But our understanding of the universe is evolving constantly with new discoveries. What will we discover next?

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This article was published as a part of Visual Capitalist’s Creator Program, which features data-driven visuals from some of our favorite Creators around the world.

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‘Urgent’ action needed in Europe over monkeypox spread: WHO – Al Jazeera English

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WHO’s Europe director calls on governments and civil society ‘to scale up efforts’ to reverse the spread of the virus.

The World Health Organization (WHO) has called for ‘urgent’ action to prevent the spread of monkeypox in Europe, noting that cases had tripled there over the past two weeks.

To date, more than 5,000 monkeypox cases have been reported from 51 countries worldwide, according to the US Centers for Disease Control and Prevention.

Infections in Europe represent about 90 percent of the global total of cases, and 31 countries in the European region have now identified cases, WHO Regional Director for Europe Dr Hans Henri Kluge said on Friday.

“Today, I am intensifying my call for governments and civil society to scale up efforts … to prevent monkeypox from establishing itself across a growing geographical area,” Kluge said in a statement.

“Urgent and coordinated action is imperative if we are to turn a corner in the race to reverse the ongoing spread of this disease,” Kluge said.

Kluge also said in his statement that there are no reported deaths from the current outbreak so far.

(Al Jazeera)

“The vast majority of cases have presented with a rash and about three-quarters have reported systemic symptoms such as fever, fatigue, muscle pain, vomiting, diarrhoea, chills, sore throat or headache,” Kluge said.

Until May, monkeypox had never been known to cause large outbreaks beyond Africa, where the disease is endemic in several countries and mostly causes limited outbreaks when it jumps to people from infected wild animals.

‘No room for complacency’

Kluge said that Europe remains at the centre of the expanding outbreak and the risk remains high.

“There is simply no room for complacency, especially right here in the European Region with its fast-moving outbreak that with every hour, day and week is extending its reach into previously unaffected areas,” he said.

The WHO does not think the outbreak currently constitutes a public health emergency of international concern but will review its position shortly, he added.

The UN agency estimates that the disease can be fatal, but smallpox vaccines are protective and some antiviral drugs are also being developed.

To date, there have been about 1,800 suspected monkeypox cases including more than 70 deaths in Africa. Vaccines have never been used to stop monkeypox outbreaks in Africa. The WHO’s Africa office said this week that countries with vaccine supplies “are mainly reserving them for their own populations”.

Most monkeypox infections so far have been observed in young men who have sex with men, chiefly in urban areas, according to the WHO. It is investigating cases of possible sexual transmission but maintains the disease is primarily spread through close contact.

Kluge said the problem of stigmatisation in some countries might make some people wary of seeking healthcare and said the WHO was working with partners including organisers of gay Pride events.

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As Monkeypox Spreads, Here's Who Should Get A Vaccine—And How – Forbes

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Topline

Monkeypox vaccines will be offered to anyone in the U.S. who thinks they have been been exposed to the virus and groups most at risk of catching it, including men who have sex with men, measures officials hope will contain the growing outbreak as they work to bolster limited supplies.

Key Facts

The new strategy recommends anyone with a confirmed or suspected exposure to monkeypox get vaccinated, expanding earlier rules limiting the shots to those with known exposures only.

This includes people who have had close physical contact with someone diagnosed with monkeypox, people who know their sexual partner was diagnosed and “men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading,” the Department of Health and Human Services (HHS) said.

HHS said it will make 56,000 doses of the Jynneos monkeypox vaccine immediately available to states from the national stockpile and will provide an additional 240,000 doses in the coming weeks.

Jynneos, produced by Danish biotech Bavarian Nordic, is given in two doses delivered 28 days apart and is the safer of two vaccines used against monkeypox.

Supplies are limited and officials said states with the highest rates of monkeypox and that have more people vulnerable to severe disease will be prioritized, with Hawaii, Massachusetts, Utah, Illinois, New York, Rhode Island, California, Colorado and Florida and Washington, D.C., slated to be in the first tier of vaccine recipients, according to a draft of the plans seen by the Washington Post.

States may also request supplies of ACAM2000, an older vaccine developed for smallpox that is also believed to protect against monkeypox and is in much greater supply, though it is associated with serious side effects and its design makes it unsuitable for immunocompromised and pregnant people.

Key Background

Monkeypox is a well-understood entity that has flared up in parts of Central and Western Africa for decades. For decades, too, monkeypox has mostly been ignored by the global community who, before this year’s outbreak, rarely encountered the disease and these instances were almost always linked to travel. It does not spread easily and is primarily transmitted through close contact with an infected animal or person or contaminated objects like towels, clothes or bedding, though it can also spread via respiratory droplets produced when people breathe, cough, talk or sneeze. Monkeypox typically causes symptoms that include fever and a characteristic rash. The infection is usually relatively mild and will go away on its own within a month or so. It can kill and cause serious illness, however, and infection is particularly risky for children and pregnant people. The virus is a close relative of smallpox, unarguably one of the deadliest diseases to plague humanity and the only human disease to have ever been eradicated. This proximity means treatments and vaccines are available for monkeypox, even if not designed for it.

News Peg

In May, the near-simultaneous emergence of monkeypox in countries where it does not usually spread in Europe and North America alarmed experts and public health authorities. Some of these experts have long warned that the complete cessation of smallpox vaccination would leave the world vulnerable to monkeypox outbreaks and the way cases cropped up suggests it may have been quietly circulating for some time. Data from the Centers for Disease Control and Prevention show there have been 351 confirmed cases of monkeypox in the U.S. as of June 29, with large clusters in California (80), New York (72), Illinois (46) and Florida (35). The official count is likely to be a severe underestimate and could be painting an overly rosy picture of the disease’s spread. Experts warn that inadequate and underwhelming testing for the virus has left the nation ignorant as to the true extent of the outbreak. Globally, the CDC said there have been more than 5,000 cases confirmed across 51 different countries by laboratory testing during the 2022 outbreak. The bulk of these have been recorded in European countries like the U.K. (1,076), Germany (874), Spain (800), France (440), Portugal (391) and the Netherlands (257). A notable cluster has also been documented in Canada (276). Many more cases are suspected, but not confirmed, and official tallies likely underestimate the number of cases, particularly in areas with poor testing infrastructure. This data also does not capture the extent of the much longer monkeypox outbreak that has been ongoing in some African countries, notably Nigeria, from earlier this year and as an endemic disease for decades. Despite seeing more infections over a much longer time period, these countries have not received any monkeypox vaccines.

Big Number

1.6 million. That’s how many doses of the Jynneos vaccine the federal government will make available this year, HHS said, including the nearly 300,000 doses already released or expected in coming weeks. HHS said it expects an additional 750,000 doses will be made available over summer and another 500,000 throughout fall. As of late June, HHS said it had already distributed more than 9,000 doses of vaccine.

What To Watch For

Vaccine supplies and changing eligibility. There is not nearly enough of the Jynneos vaccine available in the federal stockpile for everyone who might want it. There have already been supply issues in areas that launched their own initiatives ahead of the national campaign. In Washington, D.C., and New York City, for example, vaccine supplies reportedly ran out less than a day after they kick started their immunization drives. The issue could intensify if eligibility guidelines expand or the outbreak grows. Officials have acknowledged the limited supply of vaccines and suggested the national strategy may change once supplies are on firmer footing. A stronger vaccine supply chain could mean a shift to vaccinating people before they have been exposed to monkeypox, CDC director Dr. Rochelle Walensky said at a press briefing.

Tangent

While the Jynneos vaccine may be in short supply, HHS officials told Forbes there is enough smallpox vaccine in federal stockpiles to immunize the entire U.S. population. The precise breakdown is not clear, but a significant portion consists of the ACAM vaccine. There is also a third shot, the Aventis Pasteur Smallpox Vaccine (APSV), which has similar setbacks to ACAM and has not been cleared for use. The nature of the ACAM vaccine poses some unique challenges if Jynneos supplies are insufficient. Aside from the noted risk of potentially serious side effects, the vaccine uses a related virus, vaccinia, to induce a sore or pock in the recipient, usually on the upper arm. On rare occasions, this can spread elsewhere on the body or even to other people and can leave a distinctive scar. The use of live virus limits who it can be given to, notably excluding people with compromised immune systems, those in close contact with such people and pregnant people. As monkeypox cases have been reported disproportionately among men who have sex with men, this poses a potentially significant problem, as rates of people living with HIV are higher in that community. An additional issue arises with how the ACAM shot is used. It relies on an old form of immunization featuring a distinct technique and special bifurcated needle, which most practicing clinicians are unlikely to have much, if any, experience using.

Further Reading

LGBTQ Pride events offer a make-or-break moment for monkeypox (NBC News)

What To Know About How Monkeypox Spreads—And Whether You Should Wear A Mask (Forbes)

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