Changes in Mammography Use by Women’s Characteristics During the First 5 Months of the COVID-19 Pandemic

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to pre-pandemic levels and whether utilization has varied by women’s characteristics. Methods We collected data on 461,083 screening mammograms and 112,207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic, stratified by age, race/ethnicity, breast density, and family history of breast cancer. Results Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of April 2019 pre-pandemic volumes, respectively, but by July 2020 rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of July 2019 pre-pandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of July 2019 pre-pandemic volume, respectively. Conclusion Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.

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).…”

Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling

“…Our results suggest that the rapid adaptations of health-care facilities to devise strategies to resume breast cancer screening, diagnosis, and treatment services within a 6-month period greatly mitigated the potential impact on breast cancer mortality ( 2 , 9 , 13 ). The overall impact of disruptions in screening and delays in diagnosis of symptomatic evaluation were estimated to be similar, because most women due for routine screening will not have breast cancer.…”

“…Our findings also suggest that excess breast cancer mortality due to reduced access to screening during the pandemic could be mitigated by facilities giving priority to women who missed a screen during the pandemic. Although imaging volumes had returned to normal or above normal by September 2020, there remains a substantial cumulative deficit in screening and diagnostic evaluations compared with prepandemic years ( 9 , 13 , 39 ). This deficit may be due to multiple factors, including limited capacity of breast-imaging facilities to accommodate the number of women whose evaluation has been delayed, ongoing concerns from women about the safety of health-care facilities due the continued pandemic, or reduced access to health care due to COVID-19–related loss of employment-based health insurance.…”

“…For example, disruptions in screening continue as woman are being encouraged to reschedule screening mammography after receiving the COVID-19 vaccination to prevent false-positive callbacks for vaccination-related lymphadenopathy. Additionally, although mammography volumes rebounded over the summer to reach prepandemic levels ( 2 , 9 , 13 ), it is not clear what portion of these exams are for missed mammograms or regularly scheduled exams. We tested a range of assumptions about these patterns, and results were similar in magnitude across different scenarios.…”

“…Our scenarios representing pandemic impacts on screening, diagnostic evaluation of breast cancer symptoms, and treatment were based on current literature and expert opinion. In our base case, we assumed a 6-month duration of pandemic-related disruptions (March to September 2020) in screening, diagnosis, and adjuvant chemotherapy, given reports that mammography use recovered to nearly 100% by the end of summer 2020 ( 2 , 9 , 13 , 14 ).…”