Brian Sprague, PhD

Despite a strong rebound in mammography volume, a cumulative deficit in missed mammograms remains

Public health experts are beginning to look at the broader impact that the COVID-19 pandemic has had on health and wellbeing—including screening rates for cancer. A national study released this week in the Journal of the National Cancer Institute provides an analysis of mammography screening rates during the first five months of the global COVID-19 pandemic. Results show a strong rebound in breast cancer screening rates, but also uncover a cumulative deficit, as well as disparities by race, that researchers say require additional attention to understand and address.

The study, by investigators from the Breast Cancer Surveillance Coalition (BCSC), a federally-funded, national network of breast imaging registries, sought to quantify the impact that the COVID-19 pandemic had on both breast cancer screening and diagnostic mammography services in the United States. Results suggest that, despite huge declines in the early months of the pandemic, mammography volumes rebounded strongly in summer 2020, as healthcare facilities adapted new protocols to ensure staff and patient safety.

In April 2020, screening mammography utilization was only 1% of expected volume based on comparative historical data. However, by July 2020, rates had rebounded to approximately 90% of pre-pandemic volume. Similar results were observed for diagnostic breast imaging, as opposed to screening imaging, with volumes rebounding to 100% by July 2020. However, researchers note that there remains a substantial cumulative deficit in mammography screening and that rates of screening above pre-pandemic levels will be required to make up the large number of missed examinations from March through May 2020 during the initial phase of the pandemic. 

Trends in mammography screening were similar by age and risk factors in the study, but the researchers did identify disparities by race, with the rebound in mammography volume being lower among Hispanic and Asian women.

Reductions in screening and diagnostic imaging rates could lead to delays in diagnosis that cause increased morbidity and mortality due to breast cancer. The BCSC emphasizes that increased attention is needed to better understand specific barriers to healthcare utilization during the pandemic and to develop interventions to overcome these barriers.

Lead author on the study, UVM Cancer Center researcher Brian Sprague, PhD, associate professor of surgery at the University of Vermont Larner College of Medicine, notes that further BCSC research is ongoing to understand the impact of reduced mammography utilization during the pandemic on breast cancer detection and outcomes. “This national snapshot is important to help us focus research, outreach and intervention to close gaps that were perhaps created or made worse by the pandemic,” said Sprague.

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The BCSC research team included researchers from: University of Vermont Cancer Center and University of Vermont Larner College of Medicine, Burlington, VT; University of Washington and Seattle Cancer Care Alliance, Seattle, WA; University of California Davis, Davis, CA; Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, Park Ridge, IL; Kaiser Permanente Washington Health Research Institute, Seattle, WA; Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH; University of Illinois at Chicago, Chicago, IL; Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; University of California, San Francisco, CA; Department of Veterans Affairs, University of California, San Francisco, CA

More about the BCSC: https://www.bcsc-research.org/