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. 2023 Nov;202(1):105-115.
doi: 10.1007/s10549-023-06962-8. Epub 2023 Aug 16.

COVID-19 related change in breast cancer diagnosis, stage, treatment, and case volume: 2019-2021

Judith A Malmgren  1   2 , Boya Guo  3 , Mary K Atwood  4 , Paula Hallam  4 , Laura A Roberts  4 , Henry G Kaplan  4
Affiliations

COVID-19 related change in breast cancer diagnosis, stage, treatment, and case volume: 2019-2021

Judith A Malmgren et al. Breast Cancer Res Treat. 2023 Nov.

Abstract

Purpose: Evaluate the COVID-19 pandemic impact on breast cancer detection method, stage and treatment before, during and after health care restrictions.

Methods: In a retrospective tertiary cancer care center cohort, first primary breast cancer (BC) patients, years 2019-2021, were reviewed (n = 1787). Chi-square statistical comparisons of detection method (patient (PtD)/mammography (MamD), Stage (0-IV) and treatment by pre-pandemic time 1: 2019 + Q1 2020; peak-pandemic time 2: Q2-Q4 2020; pandemic time 3: Q1-Q4 2021 (Q = quarter) periods and logistic regression for odds ratios were used.

Results: BC case volume decreased 22% in 2020 (N = 533) (p = .001). MamD declined from 64% pre-pandemic to 58% peak-pandemic, and increased to 71% in 2021 (p < .001). PtD increased from 30 to 36% peak-pandemic and declined to 25% in 2021 (p < .001). Diagnosis of Stage 0/I BC declined peak-pandemic when screening mammography was curtailed due to lock-down mandates but rebounded above pre-pandemic levels in 2021. In adjusted regression, peak-pandemic stage 0/I BC diagnosis decreased 24% (OR = 0.76, 95% CI: 0.60, 0.96, p = .021) and increased 34% in 2021 (OR = 1.34, 95% CI: 1.06, 1.70, p = .014). Peak-pandemic neoadjuvant therapy increased from 33 to 38% (p < .001), primarily for surgical delay cases.

Conclusions: The COVID-19 pandemic restricted health-care access, reduced mammography screening and created surgical delays. During the peak-pandemic time, due to restricted or no access to mammography screening, we observed a decrease in stage 0/I BC by number and proportion. Continued low case numbers represent a need to re-establish screening behavior and staffing.

Keywords: Breast cancer; COVID-19; Diagnosis; Mammography; Stage; Treatment.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Consort Diagram
Fig. 2
Fig. 2
Cohort Breast Cancer Cases by Month by Year: 2019–2021 (n = 1787)
Fig. 3
Fig. 3
Swedish Breast Care Network Radiology Screening Mammograms (N = 153,174) and Diagnostic Mammograms (N = 50,266): 2019–2021
Fig. 4
Fig. 4
Swedish Breast Care Network Radiology (SBCN) Cumulative Screening and Diagnostic Mammograms 2019–2021
Fig. 5
Fig. 5
Cohort Change in Detection Method by Month: 2020 (N = 533)
Fig. 6
Fig. 6
Cohort Relative Change in Stage during COVID: pre-pandemic: 2019/Q1 2020, peak pandemic: Q2-Q4 2020, pandemic: 2021
See this image and copyright information in PMC

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