A Nashville-based chain of surgery centers says patients at its facilities have missed at least 200,000 colonoscopies this year, as the pandemic put many elective medical procedures on hold.

Colonoscopies are a big part of Amsurg’s business: Roughly 150 of its 250 surgery centers are focused primarily on gastroenterology. The company says it performs 1 of every 20 colonoscopies in the United States. So if its cancellations are any indication, millions of Americans might have a colonoscopy to make up.

And the cancellations continue. Amsurg expects another 32,000 will be missed by the end of the year.

“It’s not something everybody — maybe anybody — wakes up in the morning and says, ‘Gee, I’ve got to schedule that colonoscopy,’” says Dr. John Popp, a gastroenterologist and medical director with Amsurg.

But Popp says the procedure is also more effective than most screenings. The endoscopy can identify and remove polyps.

“Unlike any other cancer, if you find a polyp, a pre-cancerous growth, during a colonoscopy, you can remove it. If you remove it, there’s no chance of developing cancer — virtually zero,” he says.

Of the 200,000 missed procedures, Amsurg estimates 850 patients would have been diagnosed with colon cancer.

The number of people recommended to get the unpleasant procedure every 10 years is growing. Last week, the U.S. Preventive Services Task Force recommended lowering the age to start screening from 50 to 45.

While the regular screenings have helped cut colon cancer rates in older Americans, the incidence has been growing for people under 50.