Diagnostic testing ‘yet to bounce back from pandemic’

By Geir O'Rourke

20 Nov 2023

Australia needs major new investment in preventative health because testing numbers for histology and other common diagnostics remain below pre-pandemic levels, public health experts are arguing.

New data shows histology testing rates are currently between 2% and 18% below 2019 levels around the country, with campaigns to catch up on early cancer detection apparently failing to reverse the impact of COVID-19.

Full blood counts (FBCs) – one of the most frequently ordered tests in Australia – are also down in NSW and Queensland and are only just beginning to recover in other jurisdictions.

On the other hand, HbA1c assays have surged by around a third nationwide, driven by growing use of the test for diabetes screening.

Compiled by Deakin University public health academic Professor Catherine Bennett using private pathology company data, the numbers suggest at least some aspects of care are yet to fully return to normal even with restrictions no longer in place.

“While we see encouraging trends in diabetes management, reflected by a significant uptick in HbA1c testing, the persistent decline in cancer testing rates is persistently lower than in 2019,” Professor Bennett told a webinar for the Continuity of Care Collaboration last week.

“This is concerning, especially in histology, where delays in testing trends may be associated with a rise in indicating a looming crisis in late-stage cancer diagnoses, which could have been preventable with earlier detection.”

“It’s important that we understand the barriers preventing people from accessing regular cancer testing.”

It comes as the Royal College of Pathologists of Australasia warns a national shortage of pathologists is driving significant delays in turnaround times for tests, which have blown out from 2-3 days to the same number of weeks in some cases.

The college, which stresses growing complexity is another major factor, is calling for state and federal governments to fund more training positions. The latest estimates show there will be a shortage of up to 92 pathologists across Australia by 2030, it says.

The Continuity of Care Collaboration webinar also heard from Dr Rob Grenfell, a public health physician and executive at Grampians Health in Western Victoria, who said the diagnostic testing issues were having a major impact in the regions.

“An endocrinologist I’ve been speaking to has told me they’re seeing more people now coming to them with more advanced disease or more poorly controlled disease,” he said.

“Beyond that, the histopathology figures are a real warning to all of us. And again, we have anecdotal evidence that people are presenting with more advanced cancers.”

“It’s also cardiovascular disease. The head of our cath lab told me recently that people are coming in with more advanced disease because they haven’t been getting the prevention or the screening they need. These are real warning signs.”

Professor Bennett said that while the numbers presented a complex picture, they did highlight a need for better messaging to drive preventative health care.

“We also know through COVID that the way health communication worked or didn’t work varied through the population,” she said.

“You add a layer of additional fear about contracting infectious disease when there’s a surge in infections on and then maybe you lose the people that can least afford to not be engaged.”

“I do think we have to look more deeply to get a better understanding of where tests are being impacted.”

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