(219) Screening For, Diagnosing and Surgically Treating Breast Cancer in the Unites States: Impact of the COVID-19 Crisis

Publication Number: 893

Background: The COVID-19 crisis has compromised the delivery of routine of healthcare services.

Objectives: To assess the impact of the COVID-19 pandemic in the United States (US) on screening for, diagnosing and surgically treating breast cancer (BC).

Methods: Data was used from a random sample of 5.4 million US women drawn from the Komodo Healthcare Map, a large and nationally representative database of health insurance claims. BC screening by mammography, breast biopsy procedures, new BC diagnoses (i.e., BC diagnosis after 12 months without a claim for BC), and mastectomies were identified in the claims between 2016 to June 2021 (end of available data) by using CPT and ICD-10 codes. Monthly rates of mammograms, biopsies, diagnoses and mastectomies during the pandemic (from January 2020) were calculated per 100,000 female patients and compared to rates in the same month during the pre-pandemic period (mean monthly rates across 2016-2019).

Results: The number of women undergoing mammography and breast biopsy started to decrease from January 2020. The reductions were largest in April 2020, with an 88% decrease in mammograms and a 44% decrease in biopsies compared to April in the pre-pandemic period. Rates gradually went back up in May and June 2020 but never exceeded pre-pandemic rates. There were also fewer BC diagnoses in the first period of 2020, with the greatest reduction again seen in April (-26% compared to April 2016-19). In line with these results, the number of mastectomies was also lower in the first part of 2020, though the greatest reduction occurred in June 2020 (-24% compared to June 2016-19), lagging two months behind the maximum reduction in breast cancer diagnoses. In line with the apparent absence in catch ups of breast cancer diagnoses, the reduction in mastectomies in the first period of 2020 was not made up in the subsequent period until June 2021.

Conclusions: A substantial reduction in breast cancer diagnoses during the pandemic is apparent. This likely indicates diagnostic delays, which may lead to treatment delays and higher numbers of avoidable deaths due to breast cancer.