Disruptions in preventive care: Mammograms during the COVID‐19 pandemic

Abstract

Objective To measure the extent to which the provision of mammograms was impacted by the COVID‐19 pandemic and surrounding guidelines. Data Sources De‐identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. Study Design We used a difference‐in‐differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms. Data Collection We used data from the first 30 weeks of each year from 2018 to 2020. Principal Findings Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years’ and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample. Conclusions The provision of mammograms has been significantly disrupted due to the COVID‐19 pandemic.

Has COVID-19 Affected Cancer Screening Programs? A Systematic Review

“…Gastroscopies, prostate, and lung screening rates were reduced by 57%, 74%, and 56%, respectively (28,30). Screening mammograms declined by 22.2-85% (3,16,28,32). We attribute this difference to the prevalence of COVID-19 in various countries.…”

“…Seventeen studies deemed eligible for the investigation were divided into the following four categories: cancer screening and pathology samples (3,8,14,16,17,27,28,(30)(31)(32)(33), cancer diagnosis in the COVID-19 period and factors related to the reduced diagnosis of cancer (8,17,26,27,31,34,35), impact of lockdown-related delay of medical care on tumor stage at the time of diagnosis (17,25,27,30,(32)(33)(34)(36)(37)(38), mortality rate and YLLs (17,38). Based on our review using the relevant checklist, 15 studies had good quality and 1 article had moderate quality.…”

“…COVID-19 has interrupted cancer screening such that, during the pandemic, reduced rates of cancer were reported from all screening programs (3,8,14,16,17,27,28,(30)(31)(32)(33). The effect was more pronounced in countries with a greater prevalence of COVID-19 or poorly controlled rates of COVID-19 infection.…”

“…According to predictions, once the lockdown has been lifted it will take a minimum of 12-24 weeks to clear the queue of missed cancer screenings (32,38). Lang and coworkers reported that, after resuming screening, a mere 68% of the Lung Cancer Screening (LCS) reached the average weekly pre-COVID volume in the following 10 weeks (30).…”

Impact of the COVID-19 pandemic on breast cancer screening volumes and patient screening behaviors

“…As patients returned to have their postponed screening mammograms, year-over-year comparisons of the volume of weekly mammograms performed emerged as a useful way to monitor the recovery of screening exam volumes to pre-pandemic levels [ 2 , 8 ]. However, global metrics do not provide patient-level data which are important in determining individual patient populations that did and did not return for screening after having their mammogram postponed due to COVID-19.…”