Cancer screenings: The vital role of the primary care physician

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The importance of early screening for cancer cannot be understated. The earlier cancer is detected, the better the chance of having a favorable outcome.

“Primary care physicians (PCPs) play a key role in educating patients about regular cancer screenings and the benefits of early detection,” Nadia Howlader, Ph.D., from the National Cancer Institute Division of Cancer Control & Population Sciences, says. “They can explain how screenings improve survival rates and address misconceptions about delaying them, emphasizing the risks of later-stage diagnoses.”

PCPs can also provide personalized guidance based on a patient’s risk factors, such as family history or lifestyle, making screenings more relevant and urgent.

“Catching cancer in its early stages can mean the difference between a full recovery and facing a life-threatening, advanced-stage illness,” Raj Dasgupta, M.D., who specializes in internal medicine, pulmonology, critical care and sleep medicine, says. “For many common cancer types, such as breast and colorectal cancers, early detection can significantly improve the prognosis and the range of available treatment options. Now the role of the primary care physician has become even more important as doctors have had to address increased patient fears and encourage them to return to routine care.”

Mohammed Najeeb Al Hallak, M.D., M.S., co-leader of the gastrointestinal and neuroendocrine oncology multidisciplinary team for the Karmanos Cancer Institute in Detroit, Michigan, notes PCPs play a critical role in guiding patients toward understanding the importance of routine cancer screenings, such as colon and breast cancer screenings.

“They are the patients’ trusted first point of contact for health concerns, and they are the ones who recommend necessary cancer screenings based on age, risk factors and medical history,” he says. “Since the COVID-19 pandemic, this role has become even more important, as the pause of routine health care services and screenings during the pandemic caused many patients to delay or skip preventive cancer care.”

Denise Pate, M.D., internal medicine physician and medical director with Medical Offices of Manhattan in New York, New York, understands it’s up to PCPs such as herself to ensure patients have had or will be scheduled to have these screenings.

“During the COVID-19 pandemic, these routine screenings got thrown off schedule for many people, because in the height of the pandemic, many centers were focused mostly on COVID-19 and COVID-19-related illness and did not have resources available to conduct the routine screenings,” she says. “Plus, many patients were avoiding health care centers due to possible increased exposure.”

Donald Huston Jr., D.O., a primary care physician with Inspira Health in Millville, New Jersey, understands PCPs have more contact and direct interaction with patients and have established relationships that allow them to focus and facilitate discussions on this important topic.

“Today, this relationship is even more important as we try to rekindle these connections that were often strained by the pandemic,” he says. “Cancer screenings have been problematic post COVID-19, and so have routine laboratory [tests] and follow-up visits for common conditions such as diabetes, COPD [chronic obstructive pulmonary disease] and hypertension. I believe that the pandemic and all the politically-charged rhetoric associated with it have created a real lack of trust in the patient community.”

The COVID-19 challenge

Multiple studies have shown that cancer screenings across the U.S. were greatly affected by the COVID-19 pandemic.

For instance, Howlader recently led a National Institutes of Health study looking to see whether cancer incidence rates for 2021 returned to numbers they were prior to the pandemic, when cancer screening rates decreased notably.

“We would not necessarily expect every case that was missed in 2020 to be diagnosed in 2021,” she says. “Delays in screening and diagnosis may not have fully recovered by 2021, and additional cancers may be seen in future years. It is still early to tell if we have seen the complete extent of the rebound from 2020.”

Crafting conversations

PCPs are now more focused on reengaging patients, addressing safety concerns and emphasizing the long-term benefits of catching cancer early.

When addressing patients hesitant about returning to cancer screenings due to COVID-19, Howlader notes PCPs should approach with empathy, acknowledging patient concerns before presenting the facts.

“Physicians can explain how the drop in screenings during the pandemic may lead to missed diagnoses and stress the importance of early detection,” she says. “Reassuring patients about the safety measures in place, like sanitization and social distancing, is crucial.”

Dasgupta makes sure to explain the benefits of early detection in a simple, evidence-based way, talking about how it can improve survival rates.

“I also take the time to really listen to patients’ concerns and help them understand what could happen if they put off their care,” he says. “A strong relationship between a physician and patient significantly influences whether a patient participates in recommended screenings. When patients trust their doctor and feel supported, they are more likely to take proactive steps regarding their health.”

Some of the strategies Al Hallak recommends are focusing on the personalization of risk, tailoring discussions based on individual risk factors, including family history and lifestyle; using visual aids, statistics and analogies to explain the impact of delayed screenings, emphasizing the potential consequences of late-stage diagnoses; and involving patients in the decision-making process, making them feel empowered to choose their screening methods.

“Acknowledge patient concerns about COVID-19 and validate their feelings,” Al Hallak says. “Begin the conversation by recognizing the stress and uncertainty of the past few years. Reinforce the safety of health care settings. Clearly communicate the measures in place to protect patients, such as rigorous sanitization, mask policies and limited exposure times.”

Reasons for avoidance

Pate believes that some patients avoid screening because they find it an inconvenience whereas others avoid screening because they do not have any physical symptoms and therefore the screening seems unnecessary.

“There are patients who seem to think that because they have no family history of that cancer, then they are not at risk,” she says. “Each of these fallacies about screenings needs to be addressed by the patient’s primary care doctor. If the patient has trust and feels well-informed and educated, then they will be more likely to want to undergo the recommended screening.”

Huston doesn’t believe in scare tactics and won’t use guilt to persuade his patients to schedule these important screenings.

“I believe that direct discussion supported with statistical references is the only way to go,” he says. “I believe that the patient today is much more sophisticated in regard to their health, and my job is to give them direction and accurate information as a path to follow toward cancer screenings and other important testing. I can only cite the literature and try and engage them in a one-on-one conversation that allows for interaction and consideration of what I am asking them to do.”

Technology talk

To boost cancer screening rates, Howlader thinks that public health campaigns could raise awareness and health care providers can use reminders.

“Additionally, telemedicine for screening and collaborations with community organizations can improve outreach, especially in underserved areas,” she says.

Today’s PCPs can leverage technology to promote cancer screening awareness and follow-ups with patients in other ways as well.

“EMRs [electronic medical records] have features of sending alerts and flags to providers and can also serve by sending reminders to patients that they are due for their screening,” Pate says. “Many imaging centers have recall letters or messages sent to patients, whether through calls, texts or emails, particularly in the area of breast cancer screening.”

Primary care offices can also make the most of technology by using telemedicine for things such as educating patients and doing follow-ups.

“Offering online resources gives patients easy access to information about why these tests matter,” Dasgupta says.

Also, physicians can use technology to highlight the safety protocols in place for screenings post COVID-19, including enhanced sanitation, appointment spacing and telehealth consultations when possible.

“Use patient portals, reminder systems and follow-up calls to keep the conversation going,” Al Hallak says.

Still, Huston thinks many people ignore emails and that a better game plan is to directly appeal to patients with a phone call or during a visit.
“I would even go so far as to say that we should start the conversation about screenings in advance of an office visit,” he says.

The final word

It is important for the primary care physician to not let lingering COVID-19 be a concern for a patient when it comes to their future health and cancer screening.

“We are back to business as usual in medicine practices, and the world has been open for a while,” Pate says. “Cancer never stops, and so for that reason, our drive to push screening shouldn’t either.”

Dasgupta advises that if patients still express concerns about COVID-19, it’s important to acknowledge those feelings and emphasize the significant benefits of recommended screenings for their health.

“Using clear language and encouraging questions can help create a welcoming environment where patients feel comfortable discussing their health concerns,” he says. “Being empathetic and reassuring is essential.”