Population‐level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures

Abstract

BACKGROUND To understand how health care delays may affect breast cancer detection, the authors quantified changes in breast‐related preventive and diagnostic care during the coronavirus disease 2019 (COVID‐19) pandemic. METHODS Eligible women (N = 39,444) were aged ≥18 years and received a screening mammogram, diagnostic mammogram, or breast biopsy between January 1, 2019 and September 30, 2020, at 7 academic and community breast imaging facilities in North Carolina. Changes in the number of mammography or breast biopsy examinations after March 3, 2020 (the first COVID‐19 diagnosis in North Carolina) were evaluated and compared with the expected numbers based on trends between January 1, 2019 and March 2, 2020. Changes in the predicted mean monthly number of examinations were estimated using interrupted time series models. Differences in patient characteristics were tested using least squares means regression. RESULTS Fewer examinations than expected were received after the pandemic's onset. Maximum reductions occurred in March 2020 for screening mammography (−85.1%; 95% CI, −100.0%, −70.0%) and diagnostic mammography (−48.9%; 95% CI, −71.7%, −26.2%) and in May 2020 for biopsies (−40.9%; 95% CI, −57.6%, −24.3%). The deficit decreased gradually, with no significant difference between observed and expected numbers by July 2020 (diagnostic mammography) and August 2020 (screening mammography and biopsy). Several months after the pandemic's onset, women who were receiving care had higher predicted breast cancer risk (screening mammography, P < .001) and more commonly lacked insurance (diagnostic mammography, P < .001; biopsy, P < .001) compared with the prepandemic population. CONCLUSIONS Pandemic‐associated deficits in the number of breast examinations decreased over time. Utilization differed by breast cancer risk and insurance status, but not by age or race/ethnicity. Long‐term studies are needed to clarify the contribution of these trends to breast cancer disparities.

Prioritizing breast imaging services during the COVID pandemic: A survey of breast imaging facilities within the Breast Cancer Surveillance Consortium

“…Our findings are consistent with prior studies reporting sharp declines in screening and diagnostic breast imaging during March through June 2020 (EPIC Health Research Network, 2020b ; Norbash et al, 2020 ; Nyante et al, 2021 ; Song et al, 2021 ; Sprague et al, 2021 ; Whaley et al, 2020 ; Yin et al, 2020 ). The observed changes in utilization in those studies likely reflect the impact of facility closures and reduced breast imaging capacity at facilities, combined with patient willingness to attend medical clinics and patient access to medical care (e.g., loss of health insurance).…”

Significant Decrease in Annual Cancer Diagnoses in Spain during the COVID-19 Pandemic: A Real-Data Study

“…In the UK, 35% fewer diagnostic tests were performed between March and August 2020 compared to the same period in 2019 [24]. In North Carolina (USA), the monthly number of diagnostic mammography and breast biopsies was reduced to a maximum of −48.9% and −40.9%, respectively, after March 2020 [25]. The number of colonoscopies performed in England during April 2020 was 92% lower than for the same month in 2019 [17].…”

“…It should be noted that, in these two types of neoplasms, screening programs constitute a relevant procedure in their management, and perhaps this issue may have influenced the decline in their diagnoses. Although there is no data in this regard from Spain, in other countries such as UK [7,24], the Netherlands [6], Australia [26], US [9,25], or Italy [14], screening programs have been suspended during certain periods of the pandemic.…”

European trends in breast cancer mortality, 1980–2017 and predictions to 2025

“…We did not consider the potential impact of the COVID-19 pandemic on future trends in breast cancer mortality. The major short-term impact was on delayed screening in 2020 [48]. This may have some unfavourable impact on breast cancer mortality in the next several years, unless screening is promptly resumed.…”