Stamatia V. Destounis, MD, FACR, FSBI | Elizabeth Wende Breast Care
The emergence of COVID-19 in the winter of 2020, and the subsequent shut-down in many areas of the country, led to the cancellation of many routine screening examinations, screening mammography included.
At the peak of the pandemic, the Centers for Disease Control and Prevention (CDC) [1], along with individual institutions, and societies such as the American Cancer Society (ACS) and American College of Radiology (ACR) [2], recommended women postpone attending screening to not expose themselves unnecessarily to the virus. At the time, reports showed that screening rates for breast, colon, prostate, and lung cancer were already declining, ultimately revealing a significantly lower attendance rate than the baseline rates of previous years [3]. Specifically, the report from the Epic Health Research Network showed that between March 15 and June 16 an estimated 285,000 breast cancer screenings were missed [3].
As the intensity of the virus subsided, many communities were able to re-open screening services, yet apprehension over visiting doctors’ offices persisted for many, and women have continued to be faced with the decision of whether to attend their annual mammogram appointment or to further delay screening to avoid potential exposure to the virus.
Breast cancer is the most common cancer in American women (except for skin cancers), with an estimated 276,480 new cases of invasive breast cancer expected to be diagnosed in women in the U.S. in 2020 [4]– but because of the reduced volume attending screening, there was nearly a 50% drop in new breast cancer diagnoses, according to a recent study published in the Journal of the American Medical Association (JAMA) [5]. Data from the National Cancer Institute (NCI) estimates that reduced screening for six months due to COVID-19 and the resulting delays in diagnosis and treatment could lead to nearly 10,000 extra deaths from breast and colorectal cancer alone in the next decade [6].
Detecting breast cancer at routine annual screening mammography is vital to diagnose breast cancer early, when it is in its most treatable form; small, and has not spread to the lymph nodes or other parts of the body, providing the highest chance of survival. Delays in screening attendance ultimately can lead to delays in diagnoses, contributing to larger, advanced cancers being diagnosed, requiring more invasive and taxing treatment.
Understanding all the facts is crucial when deciding to attend screening or delaying screening attendance further. While postponing was prudent at one time, continued delays in routine screening does pose health risks. The risk of developing cancer does not go away just because there is a pandemic. While many women rightfully decided to put off mammograms due to immediate COVID-related concerns, it is important to be aware that medical imaging centers have safely resumed offering screening mammograms. The future spread, duration, and peaks of COVID-19 remain unclear, however, getting back in for screenings is so important for early detection. Remember, early detection saves lives.
References
- Coronavirus Disease 2019 (COVID-19). (2020). Available at https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed November 2020.
- ACR COVID-19 Clinical Resources for Radiologists. (2020). Available at https://www.acr.org/Clinical-Resources/COVID-19-Radiology-Resources. Accessed November 2020.
- Epic Health Research Network: Preventive cancer screenings during COVID-19 pandemic. Available at www.ehrn.org/wp-content/uploads/Preventive-Cancer-Screenings-during-COVID-19-Pandemic.pdf. Accessed November 2020.
- American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.
- Kaufman HW, Chen Z, Niles J, et al. Changes in the Number of US Patients With Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Netw Open. 2020; 3(8): e2017267.
- Sharpless NE. COVID-19 and Cancer. Science 2020; 368(6497): 1290.
About the Author
Stamatia Destounis, MD is a practicing radiologist at Elizabeth Wende Breast Care and Clinical Professor of Imaging Sciences at the University of Rochester School of Medicine and Dentistry.
Dr. Destounis is an ACR ultrasound and MRI accreditation reviewer and the chair of the ACR Breast MRI Quality Committee and Breast Economics Committee. She serves as chair on the SBI Patient Care and Delivery Committee and is the chair of the RSNA Breast Educational Exhibits Committee. Dr. Destounis serves as a reviewer for several peer-review journals.
Dr. Destounis is actively involved with research, acting as the principal investigator on several clinical trials conducted at her practice. Dr. Destounis’s personal research interests include digital breast tomosynthesis, screening mammography, breast ultrasound, and breast MRI, and she has published numerous peer-reviewed articles and book chapters throughout her career on these topics.
