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07-02-2023 | Breast Cancer | Breast Oncology

Breast Cancer Screening, Diagnosis, and Surgery during the Pre- and Peri-pandemic: Experience of Patients in a Statewide Health Information Exchange

Authors: Zheng Z. Milgrom, MD, MPH, Daniel P. Milgrom, MD, MS, Yan Han, MS, PhD, Siu L. Hui, PhD, David A. Haggstrom, MD, MAS, Carla S. Fisher, MD, MBA, Eneida A. Mendonca, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2023

Abstract

Background

Measures taken to address the COVID-19 pandemic interrupted routine diagnosis and care for breast cancer. The aim of this study was to characterize the effects of the pandemic on breast cancer care in a statewide cohort.

Patients and Methods

Using data from a large health information exchange, we retrospectively analyzed the timing of breast cancer screening, and identified a cohort of newly diagnosed patients with any stage of breast cancer to further access the information available about their surgical treatments. We compared data for four subgroups: pre-lockdown (preLD) 25 March to 16 June 2019; lockdown (LD) 23 March to 3 May 2020; reopening (RO) 4 May to 14 June 2020; and post-lockdown (postLD) 22 March to 13 June 2021.

Results

During LD and RO, screening mammograms in the cohort decreased by 96.3% and 36.2%, respectively. The overall breast cancer diagnosis and surgery volumes decreased up to 38.7%, and the median time to surgery was prolonged from 1.5 months to 2.4 for LD and 1.8 months for RO. Interestingly, higher mean DCIS diagnosis (5.0 per week vs. 3.1 per week, p < 0.05) and surgery volume (14.8 vs. 10.5, p < 0.05) were found for postLD compared with preLD, while median time to surgery was shorter (1.2 months vs. 1.5 months, p < 0.0001). However, the postLD average weekly screening and diagnostic mammogram did not fully recover to preLD levels (2055.3 vs. 2326.2, p < 0.05; 574.2 vs. 624.1, p < 0.05).

Conclusions

Breast cancer diagnosis and treatment patterns were interrupted during the lockdown and still altered 1 year after. Screening in primary care should be expanded to mitigate possible longer-term effects of these interruptions.

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Indiana Governor Eric J. Holcomb: 2020 Executive Orders. https://www.in.gov/gov/newsroom/executive-orders/2020-executive-orders/. 2020. Accessed February 13, 2022.

Indiana State Department of Health. Novel Coronavirus (COVID-19). https://www.coronavirus.in.gov/. 2022. Accessed 21 August 2022.

Centers for Medicare & Medicaid Services. CMS Adult Elective Surgery and Procedures Recommendations. March 2020. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf. Accessed May 14, 2020.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. https://doi.org/10.3322/caac.21590.CrossRefPubMed

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30. https://doi.org/10.3322/caac.21332.CrossRefPubMed

Breast Cancer: Statistics. https://www.cancer.net/cancer-types/breast-cancer/statistics. January 2020. Accessed May 15, 2020.

Minami CA, Kantor O, Weiss A, Nakhlis F, King TA, Mittendorf EA. Association between time to operation and pathologic stage in ductal carcinoma in situ and early-stage hormone receptor-positive breast cancer. J Am Coll Surg. 2020;231(4):434-447.e2. https://doi.org/10.1016/j.jamcollsurg.2020.06.021.CrossRefPubMedPubMedCentral

Hills N, Leslie M, Davis R, et al. Prolonged time from diagnosis to breast-conserving surgery is associated with upstaging in hormone receptor-positive invasive ductal breast carcinoma. Ann Surg Oncol. 2021;28(11):5895–905. https://doi.org/10.1245/s10434-021-09747-9.CrossRefPubMedPubMedCentral

Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to surgery and breast cancer survival in the United States. JAMA Oncol. 2016;2(3):330–9. https://doi.org/10.1001/jamaoncol.2015.4508.CrossRefPubMedPubMedCentral

10.

COVID-19 Pandemic Breast Cancer Consortium. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. National Comprehensive Cancer Network. 2020. https://www.nccn.org/covid-19/default.aspx. Accessed April 9, 2021.

11.

Society of Surgical Oncology. Resource for Management Options of Breast Cancer During COVID-19. https://www.surgonc.org/resources/covid-19-resources/. March 30, 2020. Accessed April 20, 2020.

12.

American Society of Breast Surgeons. During the COVID-19 Pandemic: Executive Summary, Version 1.0. https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19. March 24, 2020. Accessed April 19, 2020.

13.

American College of Surgeons. COVID-19 Guidelines for Triage of Breast Cancer Patients. https://www.facs.org/covid-19/clinical-guidance/elective-case/breast-cancer. March 24, 2020. Accessed April 20, 2020.

14.

Bartmann C, Fischer L-M, Hübner T, et al. The effects of the COVID-19 pandemic on psychological stress in breast cancer patients. BMC Cancer. 2021;21(1):1356. https://doi.org/10.1186/s12885-021-09012-y.CrossRefPubMedPubMedCentral

15.

Chia JMX, Goh ZZS, Chua ZY, et al. Managing cancer in context of pandemic: a qualitative study to explore the emotional and behavioural responses of patients with cancer and their caregivers to COVID-19. BMJ Open. 2021;11(1):e041070. https://doi.org/10.1136/bmjopen-2020-041070.CrossRefPubMed

16.

Miaskowski C, Paul SM, Snowberg K, et al. Stress and symptom burden in oncology patients during the COVID-19 pandemic. J Pain Symptom Manage. 2020;60(5):e25–34. https://doi.org/10.1016/j.jpainsymman.2020.08.037.CrossRefPubMedPubMedCentral

17.

Swainston J, Chapman B, Grunfeld EA, Derakshan N. COVID-19 lockdown and its adverse impact on psychological health in breast cancer. Front Psychol. 2020;11:2033. https://doi.org/10.3389/fpsyg.2020.02033.CrossRefPubMedPubMedCentral

18.

Holmes DR. Breast cancer care during a pandemic: an opportune time for cryoablation? Breast Cancer Res Treat. 2020;182(3):515–21. https://doi.org/10.1007/s10549-020-05724-0.CrossRefPubMedPubMedCentral

19.

Breast Cancer Surveillance Consortium (BCSC). Benchmarks for Cancers. https://www.bcsc-research.org/statistics/screening-performance-benchmarks/benchmarks-cancers. March 23, 2017. Accessed January 24, 2022.

20.

Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol. 2020;31(8):1065–74. https://doi.org/10.1016/j.annonc.2020.05.009.CrossRefPubMed

21.

Vanni G, Tazzioli G, Pellicciaro M, et al. Delay in breast cancer treatments during the first COVID-19 lockdown. A multicentric analysis of 432 patients. Anticancer Res. 2020;40(12):7119–25. https://doi.org/10.21873/anticanres.14741.CrossRefPubMed

22.

Cascella M, Rajnik M, Aleem A, Dulebohn S, Napoli RD. Features, evaluation, and treatment of coronavirus (COVID-19). StatPearls. 2022.

23.

Riera R, Bagattini ÂM, Pacheco RL, Pachito DV, Roitberg F, Ilbawi A. Delays and disruptions in cancer health care due to Covid-19 pandemic: systematic review. JCO Glob Oncol. 2021;7:311–23. https://doi.org/10.1200/GO.20.00639.CrossRefPubMed

24.

Milgrom Z, Severance T, Scanlon C, et al. An evaluation of an extension for community healthcare outcomes (ECHO) intervention in cancer prevention and survivorship care. Res Sq. 2021. https://doi.org/10.21203/rs.3.rs-1065059/v1.CrossRef

25.

Osterman TJ, Terry M, Miller RS. Improving cancer data interoperability: the promise of the minimal common oncology data elements (mcode) initiative. JCO Clin Cancer Inform. 2020;4:993–1001. https://doi.org/10.1200/CCI.20.00059.CrossRefPubMed

Title: Breast Cancer Screening, Diagnosis, and Surgery during the Pre- and Peri-pandemic: Experience of Patients in a Statewide Health Information Exchange
Authors: Zheng Z. Milgrom, MD, MPH
Daniel P. Milgrom, MD, MS
Yan Han, MS, PhD
Siu L. Hui, PhD
David A. Haggstrom, MD, MAS
Carla S. Fisher, MD, MBA
Eneida A. Mendonca, MD, PhD
Publication date: 07-02-2023
Publisher: Springer International Publishing
Keywords: Breast Cancer
Breast Cancer
Published in: Annals of Surgical Oncology / Issue 5/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-13119-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Breast Cancer Screening, Diagnosis, and Surgery during the Pre- and Peri-pandemic: Experience of Patients in a Statewide Health Information Exchange

Abstract

Background

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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