Some elective procedures — cosmetic surgeries or in vitro fertilization, for example — may be postponed without health risks, said Bruce McClymonds, president and CEO of West Virginia University Hospitals, where elective procedures are down.

Not so for cancer screenings.

Colonoscopies for early detection of colon cancer, for example, have risen dramatically at WVUH — until recently. “One of the things we’ve done is to very aggressively push GI (gastroenterology) services in the state and, in general, folks have responded,” said Uma Sundaram, digestive diseases chief at the West Virginia University School of Medicine.

“The number of clinic visits at WVU for GI, which, of course, translates to procedures, has gone up four- to five-fold in the last five years easily.”

But that trend has reversed in recent months, Sundaram said.

Colon cancer is the second leading cause of cancer death in the state.

A colonoscopy performed by a gastroenterologist — recommended for most people at age 50, with a follow-up in five to 10 years — is the gold standard in detection, Sundaram explained.

“Not only does it give us the best detection rate of the entire colon, but also, when we find a polyp, which is how colon cancer starts, we can take it out while we’re there,” he said. “So it’s both a diagnostic and a therapeutic procedure.”

Many of those who are due for colonoscopy are covered for it under Medicare or Medicaid, Sundaram said.

“I understand belt tightening, putting food on the table,” he said, “but they may not need to compromise on their colon cancer screening.”

Another important screening, the pap test for cervical cancer, is down alarmingly.

“If I compare December 2008 to December 2007, there’s a 35 percent reduction in the number of individuals we did a pap smear on. That’s phenomenal,” said Michael Vernon, obstetrics and gynecology chairman at WVU.

The pap smear is recommended at age 21 or within three years of becoming sexually active, and then once every one to five years.

Cervical cancer used to be a leading cause of cancer deaths among women, Vernon said. But in countries where the pap smear is routinely performed, he said, it has brought about a 99 percent reduction in cervical cancer, making it now among the last causes of female cancer deaths.

The new human papillomavirus (HPV) vaccine promises further reductions.

“Twenty-five years ago, everyone said we would cure cancer in our lifetime. Cervical cancer represents the first opportunity,” Vernon said.

But a dramatic reduction in screenings undermines that hope.

Vernon attributes the reduction not as much to poor or lost insurance as to patients’ need to save their co-pays for more immediate expenses.

“It’s so sad that we’re taking about a couple dollars’ investment that would guarantee their reproductive health,” he said, “but you can understand: $10 for food or gasoline or $10 for the doctor?”

Vernon fears a long recession.

“Once again, we’ll see women dying of cervical cancer,” he said.

A relative bright spot, at least in Morgantown, may be mammograms, recommended as a screening for breast cancer at age 40 and then yearly for most women.

“The numbers had been going up nationally,” said Judith Schreiman, professor of radiology at the WVU SOM and medical director of the Betty Puskar Breast Care Center.

“But over this last year, the last quarter particularly, nationally, the use of routine mammograms has gone down,” Schreiman said.

The numbers in West Virginia increased gradually during the past decade, from about 67 percent of woman over 40 having had a mammogram in the past two years in 1997 to about 75 percent in 2006, according to the national Behavioral Risk Factor Surveillance System.

Mammograms at the Puskar Center rose through 2007 and 2008 to, recently, 1,100 in a single month.

But Schreiman believes that number may be falling off.

“I think with this recession that the numbers of women who are doing the routine screening have gone down,” she said. The health consequences could be severe, she continued: “Increase in the stage of diagnosis for breast cancer — it will not be caught as early — and that impacts on a woman’s survival.”

Money should not be an issue, she said. Breast and Cervical Cancer Screening Program assistance from the Centers for Disease Control and Prevention is available to women everywhere based on income. Patients of the Puskar Center can get help from local funds.

“I would encourage women to please do it and, if they can’t afford it, there are services available,” Schreiman said. “We would never turn a woman away.”