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

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. Methods Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. Results By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic’s disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months. Conclusions Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.

Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic

“…A recent study of the Dutch national breast screening program similarly found that pandemic-related shutdowns had a smaller impact on non-screen detected cancer incidence than screen-detected cancer incidence ( 21 ). In a prior analysis using breast cancer models from the Cancer Intervention and Surveillance Modeling network, delays in diagnostic evaluation of symptomatic women were more detrimental to long-term outcomes than delays in screening mammography, resulting in excess breast cancer mortality ( 16 ). Thus, it is reassuring that the initial delays in breast cancer diagnoses among symptomatic women have likely largely resolved.…”

“…Less is known about the downstream impact of these observed delays in breast cancer screening, and it is not yet clear how these delays will ultimately impact breast cancer outcomes. Simulation models have predicted breast cancer screening delays due to the pandemic will lead to 2 487 excess breast cancer deaths in the US over 10 years (0.5% increase) ( 16 ). While the true impact on breast cancer mortality will not be known for many years, intermediate metrics such as cancer diagnosis rates are important indicators that warrant evaluation.…”

COVID-19 Vaccine-Associated Subclinical Axillary Lymphadenopathy on Screening Mammogram

“…However, it must be impressed that the recommendation is to perform screening mammography within a reasonable timeframe, bearing in mind that older patients are at increased risk 5 . It is estimated that there will be 2,500 additional deaths due to breast cancer because of delay in screening during the COVID-19 pandemic 13 . Further, a patient in the vaccinated cohort in our study who received the Moderna vaccine on screening mammography had a mass without axillary lymphadenopathy, resulting in biopsy-proven malignancy.…”

Barriers to breast cancer screening are worsened amidst COVID-19 pandemic: A review

“…These models suggest that the number of excess breast cancer deaths due to COVID-19 impact on screening and treatment could reach 2487 over the next decade, with a 0.52% increase in breast cancer deaths between 2020 and 2030. 32 …”

“…33 Extended hours including evenings and weekends have helped practices overcome barriers that might discourage patients from office visits. 32 …”