Pandemic Delays in Screening Mean More Breast Cancer Deaths Ahead: Study
The COVID-19 pandemic could leave a grim legacy for women's health.
New research suggests that disruptions in breast cancer screening and treatment in the United States during the COVID-19 pandemic could lead to an increase in deaths from the disease.
While mammography rates have accelerated in 2021, "facilities should prioritize screening women who missed their routine mammography exam during the pandemic" to help save lives, said study lead author Oguzhan Alagoz. He's professor in the department of population health sciences at the University of Wisconsin, Madison.
As part of pandemic-related public health measures introduced in March 2020, mammography was among the many elective procedures Americans put on hold. As a result, mammograms fell by as much as 80%, the study noted.
Also, many patients already battling breast cancer saw their treatments delayed or faced reductions in planned or expected chemotherapy treatments.
Dr. Paul Baron, director of the breast cancer program at Lenox Hill Hospital in New York City, saw all this firsthand.
"Hospitals and outpatient centers were unavailable due to limited personal protective equipment, and the need for social distancing among health care personnel and patients," said Baron, who wasn't involved in the new study.
"The result was a significant drop in numbers of women undergoing screening mammography, delays in diagnosis due to patients not seeking out their health care providers with new breast masses, and reduced use of chemotherapy for women with early-stage disease," Baron said.
To predict how these disruptions in the first six months of the pandemic will affect future breast cancer death numbers, the Wisconsin researchers turned to three independently developed breast cancer simulation models developed by the U.S. National Cancer Institute's Cancer Intervention and Surveillance Modeling Network.
Data used in the models came from the Epic Health Research Network, which collected numbers from 60 health care organizations representing 10 million women from 306 hospitals across 28 states.
The Epic data showed that about 50% of women who were scheduled to undergo screening mammograms missed their appointments. In addition, 25% of women delayed evaluations for their breast cancer symptoms, resulting in delayed diagnosis and treatment.
The models suggest that the number of excess breast cancer deaths due to the COVID-19 pandemic's impact on screening, diagnosis and chemotherapy treatment could reach 2,487 over the next decade.
That number includes 950 additional breast cancer deaths related to reduced screening, 1,314 associated with delayed diagnosis of symptomatic cases, and 151 due to reduced chemotherapy use in women with early-stage breast cancer, Alagoz and colleagues reported.
The predicted overall number of excess deaths would mean a 0.52% increase in breast cancer deaths between 2020 and 2030, according to the study published July 14 in the Journal of the National Cancer Institute.
Speaking in a journal news release, Alagoz said that many health centers have launched rapid "strategies to resume breast cancer screening, diagnosis, and treatment services" over the past six months, and that could potentially reduce the overall impact on future breast cancer deaths.
For his part, Baron agreed that "the U.S. health care system's efforts to resume normal operations likely saved lives." Nevertheless, he added, "the impact of COVID-19 will be felt for many years to come."
Dr. Nina Vincoff is chief of breast imaging at Northwell Health in Lake Success, N.Y. Reading over the new study, she said it "demonstrates that even a short delay in screening mammography can cause an increase in breast cancer deaths."
Vincoff believes that, "in the future, when pandemics or other emergencies arise, health care facilities should aim to maintain access to preventative health visits. If routine screening must be delayed during emergency situations, patients should be encouraged to return to care as soon as possible."
The American Cancer Society has more on breast cancer.
SOURCES: Paul L. Baron, MD, chief of breast surgery, director, Breast Cancer Program, Lenox Hill Hospital, New York City; Nina S. Vincoff, MD, chief of breast imaging, Northwell Health, Lake Success, N.Y.; Journal of the National Cancer Institute, news release, July 14, 2021