Q&A: Providers adapt to pandemic disruptions to provide breast cancer screenings

The COVID-19 pandemic had significant repercussions on the health care system. As lockdowns went into effect, patients postponed, canceled or simply did not make needed medical appointments.

These lapses in care included missed breast cancer screenings, which have the potential to save lives. As the pandemic continued, though, health care providers adapted. We spoke with Meghan E. Musser, DO, medical director for breast imaging at Kettering Health in Dayton, Ohio, to find out more.

Healio: What screening rates were we seeing before COVID-19, and how did the pandemic impact those rates?

Musser: As of 2018, almost 73% of American women aged 50 to 74 years were screened for breast cancer, amounting to more than 39.2 million women in the U.S., as reported by Healthy People 2030 and the FDA. At the height of the pandemic in 2020, however, mammograms plummeted to a dramatic low, decreasing by up to 92% in some areas, according to a study in the Journal of the American College of Radiology. In 2021, the number of women who were screened for breast cancer was 38.8 million, the FDA reported, suggesting that hundreds of thousands of women in the U.S. may have skipped or delayed screenings due to the pandemic. This pandemic-related decrease in screening volume has resulted in new challenges for radiologists.

Meghan E. Musser

As mammography resumed, radiologists were faced with a significant backlog of women who urgently need to be screened. At Kettering, we use the latest in artificial intelligence for breast cancer screening to help with this. ProFound AI, made by iCAD, is clinically proven to help radiologists read mammography cases more than 50% faster, with greater accuracy, which can also reduce false positives and unnecessary recalls.

Many facilities are also currently experiencing an increase in recall rates as well, with a greater amount of advanced-stage breast cancer cases present in women returning for their first mammogram since the pandemic began. At Kettering, for example, the percentage of patients requiring an invasive biopsy post-mammogram has increased by 30% since 2020.

Healio: What were the primary barriers that caused rates to fall?

Musser: At the onset of the pandemic, several medical organizations issued recommendations that women “of average risk” delay mammograms to free up resources to deal with more urgent COVID-19 cases. This guideline discouraged many women from attending their scheduled annual appointment and resulted in a significant drop in screenings that year.

As more women got vaccinated, the imaging community experienced another challenge, as new guidance was issued to wait 4 to 6 weeks after getting the COVID-19 vaccine, because the vaccine can cause swollen lymph nodes in some women.

At Kettering, we always ask women if they have been vaccinated recently so we can factor this in when looking at their images. The bottom line is that it’s more important than ever for women to be screened for breast cancer this year. Despite the disruptions and confusion COVID-19 introduced into our daily lives, it is still important to prioritize your health and be screened for breast cancer regularly.

Healio: Were some populations impacted more than others?

Musser: Yes. Screenings for women in low-income communities were disproportionately affected by the pandemic. Recent data has discovered that breast cancer screening rates at facilities in underserved communities declined by 8% (from 2019 to 2020) overall. Within some states, it was also discovered that mammogram rates were 3% lower for Black women, 27% lower for Hispanic women and 49% lower for Asian women as of July 2020.

Healio: As the pandemic has continued, has there been any progress in improving these rates?

Musser: Yes. Studies have indicated that mammogram screenings were back to 98% of pre-pandemic levels by about June 2020. This was likely a product of many imaging centers, including Kettering, making it a key priority to reach out to patients and reschedule annual mammograms.

Healio: What still needs to be done to ensure better care?

Musser: AI is one of the most effective solutions that the imaging community can leverage to provide better care to women. Adopting AI technology on a more widespread scale will allow clinicians to manage their workload more effectively and with greater accuracy, which may also help to reduce disparities in patient care.

References:

• Healthy People 2030, Increase the proportion of females who get screened for breast cancer – C-05. https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-females-who-get-screened-breast-cancer-c-05. Accessed Jan. 27, 2022.
• U.S. Food and Drug Administration, U.S. Scorecard Statistics. https://wayback.archive-it.org/7993/20201222132422/https:/www.fda.gov/radiation-emitting-products/mqsa-insights/2018-scorecard-statistics. Accessed Jan. 27, 2022.
• Duszak R, et al. J Am Coll Radiol. 2020;doi:10.1016/j.jacr.2020.06.031.
• U.S. Food and Drug Administration, MQSA National Statistics. https://www.fda.gov/radiation-emitting-products/mqsa-insights/mqsa-national-statistics. Accessed Jan. 27, 2022.
• Conant EF, et al. Radiol Artif Intell. 2019;doi:10.1148/ryai.2019180096.
• Fedewa SA, et al. Cancer. 2021;doi:10.1002/cncr.33859.
• Sprague BL, et al. J Natl Cancer Inst. 2021;doi:10.1093/jnci/djab045.