Diagnostic interval for non-screening patients undergoing mammography during the COVID-19 pandemic

Abstract

Objective During the COVID-19 pandemic, there was a temporary cessation of mammography screening. However, in some facilities, diagnostic breast imaging services continued for patients with a high clinical suspicion of breast cancer. The objective of this study was to evaluate changes in the diagnostic interval (DI) of non-screening patients presenting for diagnostic mammography during the first wave of the COVID-19 pandemic. Methods Retrospective chart review was performed on patients presenting for non-screening diagnostic mammography from April 1 to June 30, 2020 ( pandemic group ) and April 1 to June 30, 2019 ( pre-pandemic group ). Age, reason for referral, number and type of imaging studies/biopsies necessary for a final diagnosis were recorded. Diagnostic interval (DI) was defined as the number of days from the date of the diagnostic mammogram to the date of the final diagnosis. Results Compared to the pre-pandemic group (n = 64), the pandemic group (n = 77) showed a reduction in DI of the entire cohort (pandemic: 1 day; pre-pandemic: 15 days, p < 0.0001) for patients not requiring tissue sampling (pandemic: 1 day; pre-pandemic: 11 days, . p < 0.0001) and those requiring tissue sampling with benign pathology (pandemic 9 days; pre-pandemic, 33 days, p = 0.0002). A higher percentage of patients in the pandemic group had their assessment completed during the initial visit (pandemic: 50.6%; pre-pandemic: 23.4%, p = 0.0009). Conclusion During the first wave of the COVID-19 pandemic, the DI for patients with non-screening-related diagnostic mammography was significantly shorter, with a higher percentage of patients completing their assessments on the initial visit, compared to one year prior. Key Points • Despite reductions in manpower and clinical services, during pandemic times, it is possible to maintain a diagnostic breast imaging service for women at high clinical suspicion for breast cancer. • During pandemic times, breast imaging departments should consider restructuring to a Rapid Diagnostic Unit model with a navigation team that follows patients through the assessment process to a final diagnosis. • Departmental restructuring and patient navigation during pandemic times could either maintain or shorten the diagnostic interval for patients presenting for diagnostic mammography.

The COVID-19 Pandemic Impact on Breast Cancer Diagnosis: A Retrospective Study

“…In Canada, a referenced care unit for breast cancer diagnosis changed its structure to rapid diagnostic unit during the pandemic and observed a significant reduction in the time between the mammogram and the final diagnosis. 20 The reduction of time to access the service and tests for diagnosis is essential for better efficiency of early diagnosis. Among the invasive tumors, the stage profile was not different between the periods.…”

Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes

“…Forty articles identified in the review addressed screening and diagnostic services during COVID-19 ( Table 2 ). BC clinics experienced a reduction in varying breast screening procedures [ 23 , 27 , 28 , 38 , 45 , 49 ] resulting in a lower number of patients presenting to breast clinics during the pandemic [ 24 ]. Patients reported delays in BC screening services [ 35 ].…”

“…Another reason for the reduction in screening appointments was self-cancellations and missed appointments [ 17 ]; women were motivated to be screened but balanced the risk of contracting COVID-19 versus the risk of developing BC [ 32 ]. For those who did attend in-person screening appointments, women felt safe [ 41 ] and the efficacy of those visits was greater than that of pre-pandemic times [ 20 , 24 ]. Several articles addressed the recovery of cancelled and/or missed appointments following COVID-19 lockdown phases [ 25 , 42 , 44 , 47 , 48 , 56 ].…”