Breast Cancer and Covid-19: The Importance of Returning to Screening
By TRA Radiologist
Lauren Golding, MD
Early in the pandemic, non-elective medical procedures and screening exams were delayed, including annual screening mammograms. But as it became clear COVID-19 was going to be with us for a while, the risk of delaying breast cancer diagnoses could not be ignored. We know from multiple studies that regular screening mammograms help detect breast cancer early and women who undergo screening mammograms are less likely to die from breast cancer (1).
A recent large-scale study showed that even missing one scheduled mammography screening before a breast cancer diagnosis results in a significantly higher risk of dying from the cancer (2). These results are especially alarming given the staggering number of women who have missed their regular mammogram over the past 12-18 months due to the period when screening services were suspended as a result of the pandemic, as well as enduring fears and barriers caused by the COVID-19 pandemic. According to the Prevent Cancer Foundation, an estimated 35% of Americans missed routine cancer screening due to COVID-19-related fears and service disruptions early in the pandemic. Additional studies have suggested that this impact has disproportionately impacted women of color (3).
The American Cancer Society estimates that this year:
- About 276,480 new cases of invasive breast cancer will be diagnosed in women.
- About 48,530 new cases of carcinoma in situ (CIS), a non-invasive and early form of breast cancer, will be diagnosed.
- About 42,170 women will die from breast cancer.
Early detection has been key to helping to reduce the number of deaths related to breast cancer. The consequence of missing cancer screenings is that breast cancer will grow undetected—by the time a patient realizes she has cancer, it will be at a much more advanced stage and less likely curable. In a June 2020 editorial in Science, Dr. Norman Sharpless, director of the National Cancer Institute, predicted up to 10 000 excess deaths due to delayed diagnosis of breast and colorectal cancer in the United States over 10 years (4). In addition to a rise in cancer deaths, diagnosis of breast cancer at a later stage will result in the need for more aggressive treatments, including chemotherapy and mastectomy (rather than breast conservation surgery).
Of course, every patient’s circumstances and risk factors are different. But for most women, resuming routine annual screening mammography is the best way to detect breast cancer in its earliest stage. Patients can be reassured that breast imaging centers in the Triad are taking precautions to keep them healthy and reduce the risk of COVID-19 infection.
Some of these safety protocols include:
- Screening patients and staff for COVID-19 symptoms at entrances
- Universal masking
- Limiting seating and spacing out appointments to allow for social distancing, including in waiting and dressing rooms.
- Heightened cleaning/disinfecting
As a reminder, multiple societies (the American College of Radiology [ACR], the Society of Breast Imaging [SBI], and the American Society of Breast Surgeons [ASBrS]) prioritize the lifesaving benefits of screening mammography and advise women of average risk to begin screening mammography at age 40 and continue annually for as long as they are in good health.
- Monticciolo DL, Newell MS, Hendrick RE, Helvie MA, Moy L, Monsees B, Kopans DB, Eby PR, Sickles EA. Breast cancer screening for average-risk women: Recommendations from the ACR commission on breast imaging. Journal of the American College of Radiology 2017;14(9):1137–1143.
- Duffy SW, Tabár L, Yen AM, et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer. 2020;126(13):2971-2979.
- Amram O, Robison J, Amiri S, Pflugeisen B, Roll J, Monsivais P. Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State. JAMA Netw Open.2021;4(5):e2110946.
- Sharpless NE. COVID-19 and cancer. Science. 2020; 368 (6497): 1290