According to new research published in the Journal of the American College of Radiology, the coronavirus pandemic has had a significant impact on screening mammography volumes, which have not returned to pre-COVID levels (2022; https://doi.org/10.1016/j.jacr.2022.04.008).
With the aim of quantifying the initial decline and subsequent rebound in breast cancer screening metrics throughout the COVID-19 pandemic, investigators analyzed screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021.
In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were evaluated. Demographics such as patient race and age, as well as facility-regional location, community type, and facility type-were collected. The researchers used three time periods for analysis: pre-COVID 19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods.
The investigators found that all peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3 percent of pre-COVID-19 for screening mammography, 57.9 percent for diagnostic mammography, 47.3 percent for biopsies, and 48.7 percent for cancer diagnoses.
The study authors did see some rebound during the COVID-19 recover stage as a percentage of pre-COVID-19 volumes: 85.3 percent of pre-COVID-19 for screening mammography, 97.8 percent for diagnostic mammography, 91.5 percent for biopsies, and 92 percent for cancer diagnoses. Across various metrics, the researchers saw a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers.
Overall, the authors determined that the coronavirus pandemic had the greatest effect on screening mammography volumes, which they found have not returned to pre-coronavirus levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, according to the researchers, who said this finding underscores the need to increase outreach efforts directed at specific patient population and facility types.
"We undertook this project based on noting in our ACR quality registry that new data entries from participating facilities seemed to be lower than anticipated based on pre-COVID data," noted study co-author Margarita Zuley, MD, FACR, FSBI, Professor of Radiology, Vice Chair of Quality Assurance and Strategic Development, and Chief of the Division of Breast Imaging at the University of Pittsburgh Medical Center.
The finding that screening mammography volumes have not yet returned to pre-COVID levels is "multifactorial," said Zuley, noting that further investigation is needed to fully understand this particular result. "First, some patients may be hesitant to return to health care facilities due to fear of contracting COVID. Second, patients often come for their screening mammogram based on discussion with their primary care provider. If they missed their annual exam with their provider, they may be less likely to get their mammogram."
In addition, many patients have seen their employment situation change since the coronavirus pandemic's arrival in early 2020, which likely affected some patients' insurance coverage, Zuley noted. Finally, many women are the primary caretaker for their family, she added. Recent research shows that the majority of family caregivers remain women, who provide more hours of care than their male counterparts, with an estimated 59 percent of women providing 20 hours or less of unpaid care each week, compared to 41 percent of men (The State of Women and Caregiving 2022; https://bit.ly/3o1l8aH). "If their children were receiving schooling from home [during the pandemic], it would be harder for those women to find time to receive their preventative health care," Zuley noted.
Most critically, delays in mammography screening could lead to cancers being detected at a later stage. "This may impact patient morbidity and mortality from breast cancer," she said. "To start, we hope that our publication raises awareness for facilities to identify and engage patients who have not returned for their mammogram."
Zuley urges imaging departments to take the initiative in contacting female patients as one step toward returning screening mammography volumes to their pre-pandemic levels.
"Direct outreach to these women with phone calls and/or letters to assist with their scheduling an appointment and communication with their providers to encourage to return is important," she said. "Even before COVID, approximately 65 percent of eligible women actually participated in screening mammography. Therefore, facilities might use this opportunity to participate in more community outreach to raise awareness of annual screening mammography for all women ages 40 and older."
Mark McGraw is a contributing writer.