Lizzie O'Leary: I'm Lizzie O'Leary in for Tanzina Vega, and you're listening to The Takeaway. As more and more people get vaccinated against COVID-19, we're also learning of other illnesses they did not catch due to the COVID-19 pandemic.

A new report from ProPublica has documented a rising number of people diagnosed with cancer, particularly more advanced stages of cancer. It's not that more people are getting cancer, it's just that the COVID-19 pandemic prevented many people from being diagnosed earlier. It's an effect that's been felt by lots of different people, but it's particularly acute in communities of color, and the lack of preventative care may have repercussions for years to come.

Joining me now is Duaa Eldeib, an investigative reporter for ProPublica who wrote the story. Welcome to the show.

Duaa Eldeib: Thanks for having me on.

Lizzie O'Leary: Can you break down for us what happened with preventative cancer screenings and treatments last year when the pandemic started?

Duaa Eldeib: Sure. This story is really about what happened when we weren't looking when we were all focused on COVID. Immediately after the pandemic hit, preventative cancer screenings dropped by as much as 94% across the country. Chemo and radiation were suspended or delayed and in addition to people not getting their mammograms or colonoscopies, people also weren't going to the doctor.

If they were feeling symptoms, normally, they would schedule an appointment with their primary care doctor or go to the clinic, that also wasn't happening. All of that combined led to this drop in diagnoses, in some cases, by more than 50%. That was the backdrop to what we're seeing now.

Lizzie O'Leary: It sounds like it's an issue both of people not doing regular screening, but then you also had these delays in procedures that were pushed off, especially during the early days of the pandemic. Did you learn anything about the consequences of those delays?

Duaa Eldeib: Yes. At the beginning, remember the messaging was, "Don't come into the hospital unless you're very, very sick. Let's conserve resources, save them for the people with COVID." Even after that messaging shifted a bit, people were still afraid to go in.

Now looking at the aftermath, what we see are people have now started to return to the hospital and to their doctors, but they're coming in with more advanced cancers. Typically, the way that it works with cancer is, the earlier the diagnosis, the sooner treatment starts, the better the outcomes. Now, unfortunately, the effects are going to be long-lasting.

The National Cancer Institute has predicted almost 10,000 excess deaths over the next decade from breast and colorectal cancer alone, because of pandemic-related delays in diagnosis and treating those cancers.

Lizzie O'Leary: Breast cancer is one of those particular kinds of cancers where if caught early, a lot can be done. I was struck by something in your story that highlighted the disproportionate burden of breast cancer, particularly later-stage breast cancer on Latina women.

Duaa Eldeib: Yes, and that's what's so frustrating about this story. During the pandemic, what we saw was that the pandemic exacerbated a lot of structural racism that had been built into our healthcare system. People of color, communities of color were hit hardest.

Before the pandemic, Black Americans were already dying of all cancers combined at a higher rate than any other racial group. Latino Americans, cancer was the leading cause of death for Latinos, and like you said, breast cancer specifically for women. Now looking at the impact of the pandemic on cancer care, those same communities are expected to be hit particularly hard.

Lizzie O'Leary: Duaa, you wrote about this woman, Teresa Ruvalcaba, in your story and her story just floored me. Tell me a little bit about her.

Duaa Eldeib: Teresa is a 48-year-old factory worker and mother who spent almost half her life working at the same Chicago candy factory. She loves her three children, she loves her job and that's why when the pandemic hit, and many of us were able to work from home, she kept working at the factory.

She was afraid of losing her job. She was afraid of falling again behind on her mortgage, not being able to provide for her family. She was also afraid of going to the doctor or the ER in the middle of a pandemic. She ignored her symptoms. She was saying that her right breast was swelling and she was so embarrassed that somebody at the work might notice so she started stuffing her left side of her bra so no one would notice.

She grew more tired and her breast was growing more and more inflamed, but she kept going to work until one day it just got to be too much. She said, "Okay, I'm going to take time off of work, I'm going to schedule a telehealth visit, and then I'll be back at work the next day," and she did that visit but the doctor couldn't examine her in person. She examined her through a computer screen and she told her, "Oh, it looks like an infection. Here are some antibiotics."

Of course, it wasn't an infection. The antibiotics didn't work and so she ended up at the emergency room of Mount Sinai Hospital in Chicago, where she met the oncologist, Dr. Khosla, and she was later diagnosed with stage four inflammatory breast cancer.

Lizzie O'Leary: You have a description in your story of Dr. Khosla examining Teresa and that her breast felt like the skin of an orange. That it was something that Dr. Khosla doesn't even see that often because, usually, things don't get that far.

Duaa Eldeib: Right. Inflammatory breast cancer, in general, is a rare type of breast cancer. For it to get to this point was something that Dr. Khosla-- She said she hadn't seen it this severe in about a decade.

Lizzie O'Leary: What do you think Teresa's story tells us about the life of essential workers and also workers of color during this pandemic?

Duaa Eldeib: I think it just shows this huge gap in who is able to access care and who's able to get the care that they need and who can't. She started feeling symptoms last year. She was actively hiding her symptoms, ignoring them for more than six months, because she was afraid because she had to keep working. That, to me, just speaks volumes as to what's wrong with the way things are happening right now in our society.

Lizzie O'Leary: What has that six months cost her?

Duaa Eldeib: Unfortunately, at this point, her cancer has metastasized. It's spread beyond her breast to her hip and to her bones, and to her lymph nodes. What Dr. Khosla told me is that if she would have come in six months earlier, she likely would have undergone chemo and surgery and been done, but now she's incurable.

Lizzie O'Leary: It's not just the Teresas of the country who are being harmed by this right now, but when we think about the preventive screenings or the long-lasting effects that the pandemic could have on care or even on research, what have you learned?

Duaa Eldeib: Unfortunately, this is going to result in a devastating toll, loss of life, and just the ripple effects that it will have on families. The story also looks a lot at Teresa's son, Sergio, who--

Lizzie O'Leary: An aspiring doctor.

Duaa Eldeib: An aspiring doctor, yes, who graduated college and was pre-med, had all these plans to go to medical school, but he put his life on hold to come back and help with the bills, and then the pandemic hit. He said, "I'll wait a little bit longer," and then his mom got sick. Now he doesn't know when he'll be able to start back up that process of becoming a doctor and going to medical school.

Unfortunately, it's so far-reaching, and in terms of research and cancer progress, we had made so much progress in this country when it came to reducing cancer mortality. There had been a drop of 31% in cancer death rates from 1991 to 2018. Now the fear is all of that is going to be pushed back because the focus shifted. I talked to oncologists who said that they had their grants that were in the pipeline for cancer research get canceled because that money was shifting to COVID research.

Lizzie O'Leary: It's not just a question of care, but also that the singular focus on COVID has crowded out the funding for thinking about how we treat cancer in the future?

Duaa Eldeib: Absolutely. Unfortunately, what we know about cancer is that this is a field that with research we're constantly learning more, we're constantly coming up with new drugs and new treatment options. That's another lingering effect that's going to cost us in the long run.

Lizzie O'Leary: I am someone who frankly has put off my own mammogram during this. I think it's understandable that people might be nervous about going to the doctor, going to a hospital. If someone is listening to this and thinking, "Oh man, I probably do need to make this appointment," what should they know and what do experts say about the risks of COVID versus the risks of going undiagnosed?

Duaa Eldeib: I'll tell you what I heard from every single oncologist and public health expert that I spoke to for the story, which is don't delay care. At the very beginning of the pandemic, nobody knew what this-- This was a new virus. Nobody knew how it was really being transmitted, what the risks were, but now people understand and hospitals and doctors' offices have taken safety precautions to really protect people from COVID.

As one oncologist put it to me, it's much safer now to go into a doctor's office than it is to have cancer unknowingly growing inside of you.

Lizzie O'Leary: Duaa Eldeib, an investigative reporter for ProPublica wrote this incredible story. Duaa, thank you so much for being here.

Duaa Eldeib: My pleasure. Thanks so much for having me.

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