Did COVID-19 lead to an increase in rare cancer cases?

Since the pandemic began, some oncologists have noted a rise in cancer cases, including rare cancers among younger adults. Early data from national sources and some large cancer institutions also suggests that there has been an increase in aggressive, late-stage cancers.

"We started noticing some very unusual patterns," said Kashyap Patel, CEO of the Carolina Blood and Cancer Care Associates. According to The Hill, Patel and his colleagues have seen a 20% to 30% increase in new patients, multiple patients with several different cancers, couples and siblings developing cancers within months of each other, and patients relapsing after years of remission.

According to Patel, he believes that inflammation associated with COVID-19 may be contributing to this new rise in cancer cases.

"Inflammation triggers many genetic changes in a genome that can create a propensity of developing cancer in certain individuals," Patel said. "I'm analyzing close to 300 patients' data on the inflammatory biomarkers in the body with Long COVID antibodies … and if they had an unusual cancer."

David Tuveson, director of the Cancer Center at Cold Spring Habor Laboratory and former president of the American Association for Cancer Research, said there's currently no evidence that COVID-19 directly changes cells to make them cancerous.

However, he noted that some small and early studies, many of them just recently published, suggest that COVID-19 infections could cause an inflammatory cascade and other responses that could potentially exacerbate the growth of cancer cells.

According to Tuveson, he's wondered whether COVID-19 could be more like an environmental stressor that increases cancer risk, such as tobacco, alcohol, asbestos, or microplastics. "Covid wrecks the body, and that's where cancers can start," he said.

A lack of real-world evidence

So far, there is no real-world evidence connecting COVID-19 to cancer, and some scientists are skeptical about whether there's an association at all.

John Schiller, an NIH researcher who pioneered research in cancer-causing viruses, said that pathogens known to cause cancer can remain in the body long-term. However, respiratory viruses, such as COVID or influenza, are not believed to cause cancer and typically do not linger in the body.

"You can never say never, but that sort of … virus does not suggest being implicated in cancers," Schiller said.

Xuesong Han, scientific director of health services research at the American Cancer Society, said that an increase in late-stage cancers during the pandemic was likely due to patient delaying or skipping care — either for COVID-19 concerns or economic reasons. Cultural factors, language barriers, and discrimination may have also played a role.

However, Han also acknowledged that the biological mechanisms of SARS-CoV-2, the virus that causes COVID-19, could be affecting cancer risk.

"I don't have the data to support this opinion," Han said. "But it's an important question to follow up on."

More research is needed

Currently, scientists concerned about the potential link between COVID-19 and cancer have called for the U.S. government to prioritize research on the topic, since it could affect the treatment and management of millions of cancer patients for years.

According to Patel, if a link between COVID-19 and cancer is discovered, doctors could identify patients with an increased risk and implement screenings earlier. They could also put some patients on anti-inflammatory drugs, if needed.

"Mitigating risk of infection may be of particular importance for cancer patients," said Ashani Weeraratna, a professor at the Johns Hopkins Bloomberg School of Public Health. This means that preventive measures adopted early in the pandemic, such as wearing masks, avoiding crowded places, and getting vaccinated, could become even more important.

However, Douglas Wallace, geneticist and evolutionary biologist at the University of Pennsylvania, said that "[w]e are completely under-investigating this virus. The effects of repeatedly getting this throughout our lives is going to be much more significant than people are thinking."

"I would say most governments don't want to think about long covid and much less long covid and cancer," Wallace added. "It cost them so much to deal with covid. So there is very little funding for the long-term effects of the virus. I don't think that's a wise choice."

Advisory Board's oncology resources

For more insights on oncology, check out these Advisory Board resources:

Growth in demand and costs, as well as innovative technologies and disruptors, will change how cancer care is delivered, experienced, and paid for going forward. This resource outlines out four predictions for how the cancer care delivery landscape will evolve by 2030.

Separately, this expert insight explains three strategies organizations can use to leverage oncology pharmacists and improve cancer care. Similarly, these ready-to-use slides outline the major structural shifts impacting cancer care and the strategic decisions that oncology leaders will need to make.

You can also check out our upcoming webinar "Oncology market trends in 2024" on June 27. Here, we'll discuss major trends influencing today's oncology market and the implications they’ll have for stakeholders across the industry. (Schmidt, FOX 5 NY, 6/10; Johnson, The Hill, 6/10; Cha, Washington Post, 6/6)