Excess breast cancer deaths after COVID-19

 

Over the next 10 years, the delay in screening, in conjunction with a delay in diagnostic tests, may result in a significant 1% increase in deaths due to related cancers, NCI director Norman Shipman wrote in a recent Science editorial.[1] By 2030, according to modeling figures, we may expect an additional 10,000 deaths due to the breast and colon cancers. This figure does not account for other cancer types or added health problems due to upstaging.

CREDIT: (GRAPH) V. ALTOUNIAN/SCIENCE; (DATA) NATIONAL CANCER INSTITUTE

The pandemic especially affected screening rates in April 2020, when the CDC’s Early Detection Program showed an 87% decrease in breast cancer screening and 84% in cervical cancer screening.[2] The recommendations to stay home, fear over contracting COVID-19, and closure or suspension of screening services were posited as factors. As the year wore on, screenings ticked up some, but remained below pre-pandemic levels.

A study in Washington State compared the number of screening mammograms during April to December 2019 to the same time frame in 2020. In the study of 230 clinics and 8 hospitals, there was at an overall 49% decrease in screenings (55,678 screenings in 2019 vs 27522 in 2020).[3] More substantial declines appeared across certain racial and ethnic subgroups:

• Hispanic: 64%
• Native American/Alaska Native: 61%
• Mixed race: 56%
• Native Hawaiian/Pacific Islander: 54%
• Asian 54%
• Black 54%
• Rural 59%
• Urban 50%

The plunge in screening occurred on top of mammography screening rates were not stellar to begin with prior to the pandemic. In 2019, only 77% of women in the highest risk age category (50-74 years) reported having had a mammogram within the past 2 years. Rates dipped even lower among women in that age group who had less than a high school education (69%) or were at 200% below the poverty level (68%).[4] So when 2020 cut those mammogram screenings by half…well, you do the math.

[1] Sharpless NE. COVID-19 and cancer. Science 2020;368:1290 https://science.sciencemag.org/content/368/6497/1290

[2] Centers for Disease Control and Prevention. Sharp declines in breast andcervical cancer screening. Press release June 30, 2021. https://www.cdc.gov/media/releases/2021/p0630-cancer-screenings.html

[3] Amram O, Robison J, Amiri S, et al. Socioeconomic and racial inequities in breast cancer screening during the Covid-19 pandemic in Washington State. Research letter. JAMA NetWork Open 2021;4: e2110946. doi:10.1001 amram_2021_ld_210090_1620747010.03984

[4] National Cancer Institute. Cancer trends progress report. Data updated July 2021 https://progressreport.cancer.gov/detection/breast_cancer