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Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic
Kathryn P Lowry1, Michael C S Bissell1, Diana L Miglioretti1
1From the Department of Radiology, University of Washington, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and Laboratory Medicine (D.L.W.), and Office of Health Promotion Research, Department of Surgery (B.L.S.), University of Vermont Larner College of Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.).
Abstract:
Background The COVID-19 pandemic reduced mammography use, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen detected vs symptomatic) and women's characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations after mammography, US, or both with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020. The number of monthly and cumulative biopsies recommended and performed and the number of subsequent cancers diagnosed during the pandemic period (March 2020 to September 2020) were compared with data from the prepandemic period using Wald χ2 tests. Analyses were stratified by mode of detection and race or ethnicity. Results From January 2019 to September 2020, 17 728 biopsies were recommended and performed, with 6009 cancers diagnosed. From March to September 2020, there were substantially fewer breast biopsy recommendations with cancer diagnoses when compared with the same period in 2019 (1650 recommendations in 2020 vs 2171 recommendations in 2019 [24% fewer], P < .001), predominantly due to fewer screen-detected cancers (722 cancers in 2020 vs 1169 cancers in 2019 [38% fewer], P < .001) versus symptomatic cancers (895 cancers in 2020 vs 965 cancers in 2019 [7% fewer], P = .27). The decrease in cancer diagnoses was largest in Asian (67 diagnoses in 2020 vs 142 diagnoses in 2019 [53% fewer], P = .06) and Hispanic (82 diagnoses in 2020 vs 145 diagnoses in 2019 [43% fewer], P = .13) women, followed by Black women (210 diagnoses in 2020 vs 287 diagnoses in 2019 [27% fewer], P = .21). The decrease was smallest in non-Hispanic White women (1128 diagnoses in 2020 vs 1357 diagnoses in 2019 [17% fewer], P = .09). Conclusion There were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared with the same period in 2019, with Asian and Hispanic women experiencing the largest declines, followed by Black women. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Heller in this issue.
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