The fictional Ms. Smith has gotten her annual screening mammogram every April. Given that her mother, grandmother, and two sisters were diagnosed with breast cancer before 50 and had the BRCA breast cancer gene, she was vigilant about her breast health and never missed an appointment… until 2020.
As the COVID-19 pandemic intensified in March 2020, Ms. Smith was furloughed from her job and lost her mother, who was a nursing home resident. At the end of March, she received a letter in the mail stating that her annual screening mammogram would need to be rescheduled due to the pandemic.
Throughout the country, screening mammograms were rescheduled during the initial COVID-19 surge as hospitals shifted from providing elective services (including screening breast services such as mammograms, automated whole breast ultrasounds, and MRIs) to focusing on emergencies, shifting resources towards care for patients battling for their lives with coronavirus. When her new appointment card arrived in the mail, she marked her calendar for June 20, 2020. She didn’t plan on being hospitalized for three weeks in June with COVID-19.
Although she had a lengthy recovery from COVID-19 due to complications related to other underlying health issues, she finally arrived for her screening mammogram in December 2020. It had been 20 months since her last screening mammogram. So, when she got a letter in the mail recommending that she return for a diagnostic mammogram, she was rightfully concerned. When she received the results of the diagnostic mammogram that a biopsy would be necessary to confirm her breast cancer diagnosis, there wasn’t a dry eye in the room.
The Centers for Disease Control (CDC) reported that in April 2020, as compared to the previous 5-year averages for that month, the CDC’s National Breast Cancer Early Detection Program declined by 87%. Whether these women who missed their annual screening mammogram in April 2020 immediately returned to screening in the late summer/fall of 2020 remains undetermined. However, I would suspect based on what I have heard other breast imagers report, that many of these women delayed their mammogram resulting in nearly two years between screening mammograms.
Studies have shown that yearly screening mammograms detect breast cancers that are smaller and less advanced than screening mammograms every two years. What does this mean for this group of women who missed a screening mammogram due to the pandemic? Will we see more advanced breast cancers at the time of diagnosis on screening mammograms? Will more women need chemotherapy as a result of delayed diagnosis? Will we see larger breast cancers at the time of diagnosis on screening mammograms resulting in more women undergoing mastectomy versus lumpectomy?
These are all questions that remain unanswered at this time, but one can speculate that in the post-pandemic screening years we will likely see more advanced breast cancers at the time of diagnosis which in some women will likely result in more aggressive surgical treatment and possibly need for additional chemotherapy.
How many women who are at high risk for breast cancer and receive an additional screening MRI will have a delayed breast cancer diagnosis secondary to pandemic-related scheduling issues? How many women who have dense breast tissue and receive an additional screening ultrasound will have a delayed breast cancer diagnosis secondary to pandemic-related scheduling issues? We will likely never know the exact answer to any of these questions. We will also likely never know to what extent the delay affected these women regarding the need for additional surgeries or additional chemotherapy.
As a breast imager, the months of March, April, May and June of 2020 were unlike any I have seen in my career. The robes and gowns were all folded in the corner, the lockers were empty, the automated whole breast ultrasound machine was powered off, and the overwhelming silence and lack of patients in the halls was eerie. Fast forward to January 2021, the pandemic is sadly not over, but at least we have learned how to safely resume screening women for breast cancer.
I can only hope that women who have missed their annual screening mammogram, breast ultrasound, or breast MRI due to pandemic related issues have returned to their annual screening schedule. If you are overdue for your mammogram, please call to schedule your screening mammogram today. It could save your life.
Photo by Viktor Forgacs on Unsplash