Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database

Abstract

Purpose: The aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods.

Results: In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers.

Conclusions: COVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.

Keywords: COVID-19; breast biopsies; breast cancer; diagnostic mammography; screening mammography.

Fig. 1

Monthly volume of screening and diagnostic mammographic examinations from the National Mammography Database from March 1, 2019, through May 31, 2021. The green, red, and yellow boxes refer to the 3-month-long pre-COVID-19, peak COVID-19, and COVID-19 recovery periods, respectively, used for analysis. COVID-19 = coronavirus disease 2019.

Fig. 2

Monthly volume of biopsies performed and cancer diagnoses from the National Mammography Database from March 1, 2019, through May 31, 2021. The green, red, and yellow boxes refer to the 3-month-long pre-COVID-19, peak COVID-19, and COVID-19 recovery periods, respectively, used for analysis. COVID-19 = coronavirus disease 2019.

Fig. 3

Percentage of diagnostic mammographic examinations during the peak COVID-19 versus the pre-COVID-19 period by age decade with fitted trend line. COVID-19 = coronavirus disease 2019.

Fig. 4

Monthly and cumulative cancer deficits from March 2020 to May 2021 on the basis of the average monthly cancer diagnoses from March 2019 to February 2020.