Q&A: Ned Sharpless on COVID-19 and Cancer Prevention

The pandemic has raised concerns about cancer screening, while also presenting research opportunities.Norman E. “Ned” Sharpless, M.D. Photo credit: NCIOver the past year, COVID-19 affected every facet of oncology care, including prevention efforts. NCI (Bethesda, MD) director Norman Sharpless recently shared his thoughts on and screening diagnosis, outlined key questions that have emerged during pandemic. His conversation with Cancer Prevention Research Editor-in-Chief Michael Pollak, Division in Department Oncology at McGill University Montreal, Canada, touched other aspects prevention, lung modifiable risk factors.What are your screening?This is an area tremendous concern. Very disparate sets data from academic medical centers, electronic health records, CMS claims, networks, coming together giving a common answer, which dramatic way. During height last spring summer, screenings—mammography, PAP smears, low-dose CT for cancer, colonoscopy, colorectal tests—were down order 95% across country. How long stayed how quickly that's recovering still scientific interest, but this created massive deficit over 12 months—millions events been missed, it's unlikely we infrastructure to fully catch up. I think going lead cancers being diagnosed later stages. bad piece news diagnoses were 50% several months There's no reason believe incidence much; just those become apparent stage.You're saying patients symptoms not seeking care?Right. This important point. gotten lot focus because familiar patients, most get when symptomatic patient seeks evaluation, down, too. We've seen decreased rates diagnosis pancreatic malignancies typically screen detected. So, is, part, doctor evaluation.An optimistic spin would be screen-detected indolent, if you diagnose them 6 or year later, big deal. But really Pollyanna decline all screen-detected, insignificant cancers. us, me, substrate stage. One evidence I've already single institution showing there was drop pandemic, now they're starting again, finding bigger nodules than they used to.How will use unfortunate “experiment nature” study screening?We've worked hard word out regarding our missed diagnosis. good caregivers aware problem talking solutions. Groups like American Society Clinical Oncology, Radiation Association Institutes, National Comprehensive Network, College Surgeons, others started put recommendations can do care return-to-screening initiative, institutions centers reopened trying organization, so main objective ask critical raised, related prevention. question is: What value at-home screening? includes self-collection cervical sampling colon detection kits. We some that, although colonoscopy dramatically by places. promising thing learn. If enhance through sampling, particularly difficult-to-reach underrepresented populations, might better job screening.Another Can pause overdiagnosis overtreatment? Such trials very require many years observation. it opportunity did take change behavior caused act nature try understand role discerning indolent aggressive malignancy.Do expect resumption homogeneous populations?It's interesting question. Clearly, coronavirus mortality disproportionately felt certain underserved populations United States, African Hispanic patients. wonders whether disruption treatment uniformly people experiencing double whammy access care. I'd say open Centers Disease Control (CDC; Atlanta, GA) suggest pretty much wiped everybody. There may hint white resumed greater rate for, say, Indian appear disparity issues emerging return bears watching—the early sample sizes small. lately you're implementation scientist, moment arrived. That's provided address questions: Why does happen? that?Changing gears, concern SARS-CoV-2 could increase risk?That's topic given third human worldwide associated viral infection. Often, virus integrates host genome exists episomally, cases. For example, types hepatitis, appears itself driving as inflammation fibrosis promoted virus. effects viruses somewhat indirect. coronaviruses cause don't expectations should drive what do—we pay attention issue.There number ways this. parts NIH prospectively identified longitudinal cohorts we'll able follow see unexplained adverse long-term coronavirus. Most right so-called COVID (i.e., post-acute sequelae PASC), same valuable looking secondary diseases malignancy. registry studies well. Often epidemiologic studies, enough cases, issue coronavirus.Moving beyond COVID-19, expansion U.S. Preventive Services Task Force (USPSTF) guidelines?When Intervention Surveillance Modeling Network (CISNET) researchers showed me their modeling efforts, asked them, “What happen next 50 years?” thinking tobacco control new therapies, hadn't understood presented significant. make difference broad adoption, subtle: Large randomized States Europe shown something ought do, CISNET done its who exactly relevant population, led recent recommendations. That eligible factor 2, more women minority patients—African particular. headed direction. technology clearly ready, proven modality reduce mortality, it. Hopefully USPSTF announcement, got favorable attention, asking doctors screened.Of course, we're worried overtreatment, then moral hazard of, “I keep smoking screened.” not-too-distant future shows any kind program paired cessation Even therapies moderately effective impact nonmalignant huge. incentivize adoption cessation.How else help minimize risk?Education part messaging. CDC FDA funds appropriated educational initiatives, local public authorities, I'm believer NCI's measuring impacts these do? Or different things do?I obesity probably getting States. ability induce often fifth obesity, becoming soon leading factor. increasing are, obesity. where education needed, frankly science needed. need approaches deal why happens first place.Is anything you'd mention prevention?Maybe administration focused made strong statements President Joe Biden end know success regard involve screening—that goal only reducing measures.