Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population

Abstract

Purpose The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic. Methods Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in the later part of the COVID pandemic. Results Average monthly breast cancer incidence was 19.3 (95% CI 19.1–19.5) cases per 100,000 women and men pre-COVID, 11.6 (95% CI 10.8–12.4) per 100,000 in April–May 2020, and 19.7 (95% CI 19.3–20.1) per 100,000 in June 2020–February 2021. Use of pre-operative systemic therapy was 12.0% (11.7–12.4) pre-COVID, 37.7% (34.9–40.7) for patients diagnosed March–April 2020, and 14.8% (14.0–15.7) for patients diagnosed May 2020–January 2021. The changes in breast cancer incidence across the pandemic did not vary by demographic factors. Use of pre-operative systemic therapy across the pandemic varied by geographic region, but not by area socioeconomic deprivation or race/ethnicity. Conclusion In this US-insured population, the dramatic changes in breast cancer incidence and the use of pre-operative systemic therapy experienced in the first 2 months of the pandemic did not persist, although a modest change in the initial management of breast cancer continued.

Changes in the number of cancer diagnosis practices due to the COVID-19 pandemic: interrupted time-series analysis using the National Database of Japan

“…A drastic decline in the number of diagnostic practices and diagnosis in the early stages of the initial COVID-19 pandemic has been observed in several countries and have recovered within a short period of time (Castonguay et al 2022 , Caswell-Jin et al 2022 , Dinmohamed et al 2020b , Tachibana et al 2021 , Vrdoljak et al 2021 ). In Japan, the first state of emergency was declared from April 7, 2020, to May 25, 2020, but no lockdown was implemented.…”

Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan

“…Several societies, including the Japan Breast Cancer Society, recommend considering this treatment for early-stage patients with breast cancer in the guidelines for treating breast cancer during the COVID-19 pandemic 14,16,35 . Neoadjuvant therapy has been implemented in the United States 17,23 and Canada 36 ; however, the situation in Japan remains to be confirmed. Patient prognosis differs depending on the reason for the reduction in surgery.…”

“…Furthermore, some symptomatic patients may have avoided visiting the clinic due to fear of infection. Under these situations, breast cancer diagnosis had decreased worldwide 7 , 17 – 22 . Given these facts, a decrease in the number of surgeries for breast cancer during the pandemic was expected, and this has already been confirmed in various countries, including the United States 8 , 23 – 25 , the Netherlands 26 , Turkey 27 , Lithuania 11 , South India 9 , and South Korea 19 .…”

Rates of newly diagnosed breast cancer at commission on cancer facilities during the early phase of the COVID‐19 pandemic

“…Only a few studies have examined the number of breast cancer cases diagnosed during the pandemic 6,22–25 . Most of these studies used databases that did not account for a majority of cancer cases or were single institution studies.…”