Pictured: Brian Sprague, Ph.D., (left); Sally Herschorn, M.D. (center); and Donald Weaver, M.D. (right).

Study highlights racial disparities in biopsies and detected breast cancers during a 2020 span when routine screenings were greatly slowed

New research from U.S. Breast Cancer Surveillance Consortium (BCSC) members, including several University of Vermont researchers, found that from March to September 2020, breast biopsies and detected cancers at U.S. BCSC facilities dropped sharply, compared with the same span a year earlier. Biopsies declined by 23 percent and detected cancers by 24 percent – findings that the research team attributes mostly to the postponement of routine screening mammograms as the COVID-19 pandemic took hold. 

The findings were published recently in Radiology. UVM Associate Professor of Surgery Brian Sprague, Ph.D., is senior author on the paper, and Professor of Radiology Sally Herschorn, M.D., and Professor of Pathology and Laboratory Medicine Donald Weaver, M.D., are coauthors. All three are also members of the UVM Cancer Center.

“The large deficit in breast cancers detected by screening during 2021 raises concern that cancers we would have hoped to detect early with screening will now present symptomatically or through delayed screening at a more advanced stage in the coming year,” said Sprague.

Weaver explains, “Breast cancers that are self-detected or cancers discovered by mammogram after missed screening exams tend to be larger and pathologically more aggressive than those detected by routine screening.”

Additionally, the research suggests that those postponed mammograms appeared to disproportionately affect women of color, as breast cancer diagnoses during the span diminished at different rates across demographic groups: Non-Hispanic white women had 17 percent fewer breast cancer diagnoses, while the year-over-year decline was 53 percent for Asian women, 43 percent for Hispanic women, and 27 percent for Black women.

“We know that prolonged delayed screening (more than a few months) will result in more cancers detected at larger sizes and later stages, making treatment more difficult,” said Hershorn. “We do not know the long-term effects of this on prognosis.”

Back on March 26, 2020, the American College of Radiology and American Society of Breast Surgeons jointly recommended that medical facilities immediately postpone all breast cancer-screening exams. Three weeks later, on April 16, the Society for Breast Imaging issued guidelines for resumption of breast cancer screening. That guidance noted, however, that the facilities’ ability to offer screening would depend on many factors, including the local COVID-19 burden, the availability of personal protective equipment, and the ability of breast surgeons and oncologists to manage newly diagnosed breast cancer patients.

Medical facilities rolled out COVID-19 safety protocols and, as October began, the American College of Radiology launched a “Return to Mammography” initiative, encouraging women who had missed a screening to return as soon as possible.

These efforts appear to have been largely successful. As early as July 2020, monthly biopsies and cancer diagnoses had returned to near-normal, even as total year-over-year cancer diagnoses remained lower. The new findings suggest, though, that breast imaging facilities may be struggling to meet demand for rescheduled examinations.

“All facilities in the BCSC were having difficulty catching up on screening backlogs,” Herschorn said. “We are seeing patients who usually screen every year coming in at 15, 18, or 24 months from their last mammogram. Some of this is access, but some may be hesitancy due to COVID-19 or other family obligations that make going for routine care difficult.”

First author Kathryn Lowry, M.D., assistant professor of radiology at the University of Washington School of Medicine, suggested that it’s likely that women of color have faced greater barriers to returning for routine mammograms based on evidence demonstrating that U.S. communities of color have borne the brunt of COVID-19’s trauma. 

“These communities have disproportionately experienced SARS-CoV-2 illness and mortality, as well as economic hardship due to job losses during the pandemic,” said Lowry. “It’s also possible that some medical facilities serving these communities have been less able to compensate for increased demand.”

Lowry noted that the researchers’ just-published results do not account for the delta variant surge, which peaked only a month ago.

“Based on our findings, particular efforts are needed to facilitate utilization of breast cancer screening among communities of color during the pandemic,” added Sprague.

The research was supported by the National Cancer Institute (R01CA248068, R50CA211115, P01CA154292, U54CA163303, P30CA014520, and P20GM103644); the Patient-Centered Outcomes Research Institute (PCS-1504-30370); the Agency for Healthcare Research and Quality (R01 HS018366-01A1); and the Breast Cancer Surveillance Consortium. The collection of SABIR data was supported by the UC Davis Comprehensive Cancer Center, the Placer County Breast Cancer Foundation, and the UC Davis Clinical and Translational Science Center.

(This article was adapted from a press release written by Brian Donohue of the University of Washington School of Medicine.)