Breast cancer screenings have yet to return to pre-pandemic levels, and providers are seeing some patients with more advanced cancers.
Pink is everywhere in October for Breast Cancer Awareness Month.
Buildings and public spaces, including the White House, have been bathed in pink, fountains spout pink water, and stores display plenty of pink products. Scores of breast cancer charity walks take place on October weekends.
Despite the seemingly ubiquitous awareness campaign, health systems say fewer women have been getting screened for breast cancer. The number of women getting mammograms dropped during the COVID-19 pandemic, and it hasn’t recovered yet.
Sara Veldman, a diagnostic radiologist with Allina Health, said even this year, the number of women coming in for screenings is probably about 80% of pre-pandemic levels.
Veldman told Chief Healthcare Executive that she’s concerned because typically many women get screened in the fourth quarter of the year.
“This year, we have not been close to normal numbers,” Veldman said.
Health systems around the country said they are seeing fewer women getting screened for breast cancer than in the years before the arrival of COVID-19. Some said they are seeing patients who skipped an annual screening or two that are now being diagnosed with breast cancer, some with more advanced stages.
Katie Couric disclosed last month that she was diagnosed with breast cancer in June 2022. In an essay she wrote about her diagnosis and her treatment, Couric said that she had missed her annual mammogram, and was screened in December 2020. The broadcast journalist wrote that she typically never missed screenings; she lost her husband, Jay, to colon cancer in 1998.
“I was six months late this time,” Couric wrote. “I shudder to think what might have happened if I had put it off longer.”
In her poignant essay, Couric urged patients to get their mammograms, and to find out if they need additional screenings for dense breasts.
Sarah M. Friedewald, communications chair of the American College of Radiology® (ACR®) Breast Imaging Commission, wrote on the ACR’s website about the importance of reminding patients to get their annual screenings.
“More than 35,000 breast cancer diagnoses may be delayed and an additional 5,200 women may die in the United States over the next decade as a result of screenings canceled due to the pandemic,” Friedewald wrote. “While it was important to play it safe by delaying non-urgent care during the pandemic, it’s time for women ages 40 and older to resume yearly mammography screenings.”
Patients of color are at greater risk if they aren’t screened regularly. Minority women under 50 are 72% more likely to be diagnosed with breast cancer and are 127% more likely to die of the disease, compared to white women, she wrote.
Screening mammograms recovered to a degree from the nadir seen during the worst of COVID-19 cases, but they still haven’t rebounded to pre-pandemic levels, according to a study published in August The Journal of the American College of Radiology.
Researchers have found steep drops in cancer screenings, according to a study published in Cancer in March. The study, which examined hundreds of cancer programs between April and June 2021, found a 55% drop in breast cancer screenings, along with an 80% drop in colon cancer screenings and a 69% decline in screenings for cervical cancer.
Cancer diagnoses are down across the board, according to an analysis by Quest Diagnostics, which was published by the Journal of Clinical Oncology Clinical Cancer Informatics. From April 2021 to March 2022, cancer diagnoses were 11% less than pre-pandemic levels. In that same period, breast cancer diagnoses remained 17% lower than before the pandemic.
Dr. Harvey Kaufman, senior medical director of Quest Diagnostics and the author of the study, said he expected to see a bigger rebound in cancer diagnoses.
“It was surprising to us that in the second year of the pandemic, there was still this big decline,” Kaufman told Chief Healthcare Executive.
Health system leaders have said they are dealing with many patients who deferred healthcare tests and treatment during the pandemic, and now they are starting to see those patients showing up in hospitals.
Some of those patients are sicker and need longer and more expensive hospital stays, according to an American Hospital Association report released in August.
‘Fallen off that natural cycle’
Dr. Aurora Luna, a radiologist with GenesisCare in Boca Raton, said she has seen patients who have delayed mammograms, even those who had been consistent with annual screenings.
Luna said some who came once a year, perhaps on a birthday, haven’t kept up in the pandemic.
“It’s hard for them to come back in the swing of things,” Luna said. “They have fallen off that natural cycle.”
Veldman said she’s particularly concerned that the number of screenings this month, and in the fourth quarter, remain lower than pre-pandemic years.
“A lot of women just naturally do their annual testing in the last quarter of the year,” she said. “We’re definitely seeing a decline in this last quarter.”
Some patients who are coming back to get overdue screenings are being diagnosed with breast cancer, and the cancers are more advanced, Veldman and Luna said.
“We are finding cancers that are slightly more progressed due to the delay in screening,” Veldman said.
“Women weren’t coming in for screening. Then they were ignoring symptoms,” she said.
While many Americans have resumed mostly normal activities with the drop in COVID-19 cases, Veldman has dealt with patients who worked from home and are still largely limiting activity in public places. And that includes visiting doctors’ offices.
“Some flat out admitted, I knew I had this lump in my breast but I wasn’t leaving the house,” Veldman said.
And she also said she’s dealt with patients that have no trouble shopping at a retail store without a mask but remain wary of going to a doctor’s office or a hospital.
Luna said she’s seen patients recently diagnosed with breast cancer after skipping screenings, and those cancers could have been detected at earlier stages.
“If you show up every year for your mammogram, that’s the best chance we’ll get for catching something early,” Luna said.
‘Get people back in’
Doctors are worried about the prospect of seeing more patients diagnosed with more advanced stages of breast cancer, and other cancers, in the years to come because of patients skipping annual screenings.
They fear patients will face longer recoveries. And they said soberly, they are worried that breast cancer deaths could rise in the coming years, due to the drop in screenings seen in the pandemic.
“This is going to impact healthcare in a big way,” Kaufman said. “It’s going to impact patients.”
“Cancer didn’t care about the pandemic,” he added. “Some of these patients are going to present at more advanced cancer.”
Kaufman said health systems and physicians must take responsibility and engage patients who have missed mammograms, and other cancer screenings.
“Physicians can do more with telemedicine, reaching out to patients who they haven’t seen for an extended period of time,” he said.
Hospitals and health systems need to “create solutions to get people back in.”
Veldman offered a personal pitch to those who have been putting off exams.
“I encourage women to do it for themselves, or do it for someone you love, and that loves you,” Veldman said. “Your friends, your family, your coworkers, there’s a lot of people that want you to be healthy.”