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COVID-19 Pandemic Delayed Breast Cancer Screening in Many Parts of the United States

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Breast cancer screening tests, including mammograms, ultrasounds, and MRIs, were delayed as a result of the COVID-19 pandemic, according to two studies.

The research was presented on July 22, 2020, as part of the American Association of Cancer Research Virtual Meeting: COVID-19 and Cancer. These abstracts are not yet available to the public:

  • Patient-Reported Impact of the COVID-19 Pandemic on Breast Cancer Screening, Diagnosis, and Treatment: A National Survey
  • Impact of COVID-19 on breast and prostate cancer screening and early detection in a large healthcare provider group

COVID-19 and breast cancer

Coronaviruses are a large group of viruses that can cause respiratory illness in humans and animals. The relatively new coronavirus we’ve all heard so much about is called SARS-CoV-2, and the illness it causes is called coronavirus disease 2019, which is why it’s abbreviated as COVID-19.

The virus that causes COVID-19 is very, very contagious — about 3 times as contagious as the flu virus. It spreads mainly through droplets of fluid produced when a person coughs or sneezes. People who are within 6 feet of an infected person may then inhale or otherwise get the droplets into their noses, mouths, or eyes.

To date, there is no vaccine or completely effective treatment for COVID-19.

Because COVID-19 is so contagious, many hospitals and other healthcare facilities delayed or cancelled elective procedures beginning in March 2020. Elective procedures included anything that didn’t need to be done to save someone’s life. Breast cancer screening was considered an elective procedure, so many mammograms were delayed or cancelled. Some breast cancer surgeries and other treatments also were delayed, changed, or cancelled.

COVID-19 did not hit the United States evenly. Some states reported thousands of cases, while others reported only a few hundred. So delays in breast cancer screening and care were different in different places. The researchers who did these two studies wanted to document the delays that took place.

About the first study

The first study was done by researchers at Massachusetts General Hospital and used an online survey to ask people about any delays or cancellations of breast cancer screening or care, as well as how worried they were about the COVID-19 pandemic making it harder to get healthcare, including breast cancer treatment.

The survey was available in both English and Spanish. The English version was available from May 14 to July 10, 2020. The Spanish version became available on June 1 and was still accepting responses at the time of this report. The survey was promoted through several breast cancer advocacy organizations, including the Dr. Susan Love Foundation and SHARE.

For this analysis, 534 people completed the survey:

  • 46.1% had been diagnosed with breast cancer at some point in their lives
  • 5.4% were in the process of being diagnosed with breast cancer
  • about half were between the ages of 50 and 69
  • about 50% were white, about 21% were Black, and about 5% were Latinx
  • about 10% had Ashkenazi Jewish heritage

More than a quarter of the respondents said they had experienced a delay in healthcare:

  • 31.7% of people who had been diagnosed with breast cancer reported a delay in care; of these people, 22% said they had a delay in screening and 9.3% reported a delay in treatment
  • 26.7% of people who had never been diagnosed with breast cancer reported a delay in care; of these people, 31.5% said they had a delay in screening and 1.6% said they had a delay in treatment, though since they hadn’t been diagnosed with breast cancer, the researchers assumed this was a delay in some other type of treatment

“Our survey shows that the COVID-19 pandemic has disrupted breast cancer screening, including surveillance among women who have been diagnosed with breast cancer,” said Erica Warner, MPH, assistant professor of medicine at Harvard Medical School, who presented the results. “Our next steps will be to see if the affect of the pandemic on breast screening differed by demographic, geographic, or other respondent characteristics.”

Warner pointed out that many doctors are concerned about the long-term effects of delays in breast cancer screening.

“Delays in screening can lead to delays in diagnoses,” she said. “In his June 19 editorial in Science, Dr. Norman Sharpless, director of the National Cancer Institute, said that modeling predicts an excess of 10,000 deaths from breast cancer and colorectal cancer over the next 10 years because of the pandemic.

“We need to implement strategies to help people return to care,” she added. “We need to emphasize how important screening is and let them know about the measures being taken to ensure their safety.”

About the second study

The second study was done by researchers at the University of Massachusetts Medical School. The researchers looked at the medical records of women and men age 30 to 85 who had not been diagnosed with breast or prostate cancer. By looking at the codes in their medical records, the researchers determined how many people had either breast cancer or prostate cancer screening tests or a biopsy. All the people were patients of the same healthcare group.

The researchers compared the monthly rate per 1,000 people of breast/prostate cancer screening or biopsy from January to May 2019 to the number of people who had the same procedures from January to May 2020.

For this Breastcancer.org review, we will only focus on the breast cancer screening and biopsy results. For this study, breast cancer screening included 2D mammograms and digital tomosynthesis (3D mammograms).

Overall, 80,629 women were included in the 2019 analysis and 82,695 women were included in the 2020 analysis. About half the women were younger than 52 and half the women were older.

The researchers found that breast cancer screening decreased dramatically from 2019 to 2020:

  • an average of 13.6 2D mammograms per 1,000 women per month were done from January to May 2019
  • an average of 6.1 2D mammograms per 1,000 women were done in March 2020
  • an average of 0.25 2D mammograms per 1,000 women were done in April 2020
  • an average of 1.1 2D mammograms per 1,000 women were done in May 2020
  • an average of 34.7 3D mammograms per 1,000 women were done from January to May 2019
  • an average of 14.6 3D mammograms per 1,000 women were done in March 2020
  • an average of 1.4 3D mammograms per 1,000 women were done in April 2020
  • an average of 1.5 3D mammograms per 1,000 women were done in May 2020

Breast biopsies also declined from an average of 0.9 per 1,000 women per month in 2019 to:

  • 0.8 per 1,000 women in March 2020
  • 0.4 per 1,000 women in April 2020
  • 0.1 per 1,000 women in May 2020

Mara Epstein, ScD, assistant professor of medicine at the University of Massachusetts, echoed Warner’s concerns about delays in screening leading to delays in diagnosis, which will likely lead to worse breast cancer outcomes.

“In central Massachusetts, we saw a precipitous decline in preventive and diagnostic procedures for breast and prostate cancer during the peak of COVID-19,” said Epstein, who presented the research. “The long-term impact on delay in cancer diagnosis and cancer prognosis is unknown, but Dr. Sharpless’s models estimate a large number of excess deaths.”

What this means for you

When the COVID-19 pandemic first started, many medical procedures considered non-urgent were delayed or cancelled. This was primarily for two reasons:

  • to save medical resources, including doctors’ and technicians’ time, personal protective equipment, medicines, and emergency room and intensive care unit beds, for people who were infected with COVID-19
  • to help reduce the risk of people becoming infected with COVID-19 by keeping them out of hospitals and other care facilities where COVID-19 patients were being treated

As time has passed, doctors have seen how protective procedures, such as wearing a face mask, washing your hands, maintaining physical distancing, and avoiding gathering with people in a group, have helped slow the spread of the virus.

So now many facilities are once again offering breast cancer screening. In fact, because many facilities have been closed for several months, you may find you can call and get an appointment for your mammogram the same week.

Most doctors agree that breast cancer that is diagnosed early is typically easier to treat and offers the best survival chances. Regular screening for breast cancer, including annual mammograms and breast exams by a medical professional, is important for everyone.

If your annual mammogram was delayed by the COVID-19 pandemic, Breastcancer.org urges you to call your facility and reschedule. If you’re concerned about COVID-19, it makes sense to ask what steps are being taken to protect you from the virus. Many facilities have hotlines you can call. It also makes sense for you to take steps on your own to protect yourself from COVID-19, including:

  • not touching your face while you are at the facility
  • wearing a face mask
  • using hand sanitizer when you leave the facility
  • washing your hands as soon as you get home

Of course, if you have any COVID-19 symptoms, such as cough, shortness of breath, or loss of sense of smell, cancel your appointment, get tested for COVID-19, and self-quarantine for the required amount of time if you test positive.

Written by: Jamie DePolo, senior editor

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