Lars Grimm, MD, MHS, Member of the American College of Radiology® (ACR®) National Mammography Database (NMD) Committee, contributed this piece.
A recent study explores the impact of COVID-19 on breast cancer screening outcomes using data available in the NMD, which includes 5.6 million screening mammograms, 1.2 million diagnostic mammograms, 200,000 breast biopsies and 70,000 cancer diagnoses. Investigators from the NMD Committee and the Harvey L. Neiman Health Policy Institute explored the impact of COVID-19 during the peak of the pandemic, from March 2020 to May 2020, and then the COVID recovery period one year later. The results, published in the Journal of the American College of Radiology, confirm the firsthand experience of breast radiologists nationwide with major drops in screening mammograms at 63.7%, diagnostic mammograms at 42.1%, breast biopsies at 52.7% and cancer diagnoses at 51.3, compared to pre-pandemic levels.
Widespread efforts from the ACR and Society of Breast Imaging during the peak of the pandemic aimed to encourage women to safely return to screening practices, but little was known about the success of these efforts. Although diagnostic mammogram levels returned to near pre-pandemic levels at 97.8%, screening mammograms, breast biopsies, and most importantly cancer diagnoses, continue to lag. The sluggish recovery metrics were most prevalent among older women and Asian women.
These findings are likely to have a major impact on future breast cancer outcomes. The cancer diagnosis deficit that started in the acute phase of the pandemic continues to grow, in parallel with lower screening mammography utilization rates. Failure to diagnose smaller, screen detected cancers will lead to more late-stage cancers in the future. Initial cancer registry data demonstrates a stage shift to later-stage breast cancers, and multiple modeling studies predict a corresponding increase in patient morbidity and mortality. As the most comprehensive national registry of breast cancer screening practices in the United States, the NMD provides the best means of studying these national trends.
The true impact of the COVID pandemic on breast cancer screening and outcomes will likely not be understood for many years, but initial signs all point to worsening patient outcomes. Radiologists, medical centers and national organizations must redouble their outreach efforts to encourage patients to return to their pre-pandemic screening mammography practices, especially for Asian women and older women.
Only through more direct engagement with our patients can we seek to minimize the impact of COVID on breast cancer outcomes. Resources such as the ACR “Continue Mammography Care” toolkit and information on MammographySavesLives.org can help radiologists and referring providers ensure their patients are receiving these lifesaving screenings.Please share your thoughts in the comments section below, and join the discussion on Engage (login required).