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Objective To measure the extent to which the provision of mammograms was impacted by the COVID‐19 pandemic and surrounding guidelines. Data Sources De‐identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. Study Design We used a difference‐in‐differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms. Data Collection We used data from the first 30 weeks of each year from 2018 to 2020. Principal Findings Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years’ and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample. Conclusions The provision of mammograms has been significantly disrupted due to the COVID‐19 pandemic.

Background Decisions for operative or nonoperative management remain challenging for patients with spinal metastases, especially when life expectancy and quality of life are not easily predicted. This study evaluated the effects of operative and nonoperative management on maintenance of ambulatory function and survival for patients treated for spinal metastases. Methods Propensity matching was used to yield an analytic sample in which operatively and nonoperatively treated patients were similar with respect to key baseline covariates. The study included patients treated for spinal metastases between 2005 and 2017 who were 40 to 80 years old, were independent ambulators at presentation, and had fewer than 5 medical comorbidities. It evaluated the influence of operative care and nonoperative care on ambulatory function 6 months after presentation as the primary outcome. Survival at 6 months and survival at 1 year were secondary outcomes. Results Nine hundred twenty‐nine individuals eligible for inclusion were identified, with 402 (201 operative patients and 201 nonoperative patients) retained after propensity score matching. Patients treated operatively had a lower likelihood than those treated nonoperatively of being nonambulatory 6 months after presentation (3% vs 16%; relative risk [RR], 0.16; 95% confidence interval [CI], 0.06‐0.46) as well as a reduced risk of 6‐month mortality (20% vs 29%; RR, 0.69; 95% CI, 0.49‐0.98). Conclusions These results indicate that in a group of patients with similar demographic and clinical characteristics, those treated operatively were less likely to lose ambulatory function 6 months after presentation than those managed nonoperatively. For patients with spinal metastases, our data can be incorporated into discussions about the treatments that align best with patients’ preferences regarding surgical risk, mortality, and ambulatory status.

JAMDA j o u r n a l h o m e p a g e : w w w . j a m d a . c o m

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Open Access. This is an open access article distributed under the terms of the CC-BY License.