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Cohen EO, Edelkamp P, Sun J, Leung JWT. Breast Imaging Patient Demographics at a Major Comprehensive Cancer Center Before and During the COVID-19 Pandemic. J Am Coll Radiol 2024; 21:576-588. [PMID: 37952808 DOI: 10.1016/j.jacr.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The coronavirus disease of 2019 (COVID-19) pandemic disproportionately affected certain vulnerable communities. The purpose of our study was to determine how COVID-19 affected the socioeconomic demographics of breast imaging patients at a major comprehensive cancer center. METHODS This retrospective cohort study compared female patients who underwent screening mammograms, diagnostic mammograms, breast ultrasound, or breast MRI during the following time periods: prepandemic (February 1, 2018, through February 29, 2020), acute pandemic (March 1, 2020, through June 30, 2020), subacute pandemic (August 1, 2020, through December 31, 2020), and chronic pandemic (January 1, 2021, through June 30, 2022). Statistics were performed using the generalized estimating equations approach. RESULTS A total of 74,398 female patients (mean age, 55.6 ± 12.4 years) underwent 238,776 total breast imaging examinations. For screening mammograms, Hispanics represented 27.1% (9,197 of 33,960) of patients in the prepandemic time period compared with 16.7% (604 of 3,621) in the acute pandemic time period, 18.7% (1,835 of 9,830) in the subacute pandemic time period, and 24.3% (7,492 of 30,869) in the chronic pandemic time period (all P < .0001). Self-pay patients saw similar declines for screening mammograms during the same time periods: 21.7% (7,375 of 33,960), 7.9% (286 of 3,621), 9.5% (933 of 9,830), and 17.4% (5,357 of 30,869), respectively (all P < .0001, compared with the prepandemic time period). Similarly dramatic trends were not observed for race or other imaging examinations. DISCUSSION At our cancer center, Hispanics and self-pay patients were disproportionately affected by the COVID-19 pandemic. Strategies to improve health inequities are needed.
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Affiliation(s)
- Ethan O Cohen
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Paul Edelkamp
- Division of Information Services, Enterprise Data Engineering, and Analytics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jessica W T Leung
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Deputy Chair, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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2
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Hillman AK, Ramis P, Nielsen P, Rohren EM. Impact of the COVID-19 Pandemic and Vaccine Availability on Utilization of Breast Imaging in a Multistate Radiology Practice. Radiol Res Pract 2024; 2024:6653137. [PMID: 38371341 PMCID: PMC10872212 DOI: 10.1155/2024/6653137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Method Data were obtained from medical health records across 77 Radiology Partners practices in the US. The data provided us with the total monthly mammography, breast ultrasound, and breast MRI procedures from January 2019 to September 2022. An interrupted time-series (ITS) analysis was conducted to evaluate the effect of the COVID-19 pandemic and the COVID-19 vaccination. We chose March 2020 and December 2020 as critical time points in the pandemic and analyzed trends before and after these dates. Results The starting level (at baseline in January 2019) of the total breast imaging procedure volume was estimated at 114,901.5, and this volume appeared to significantly increase every month prior to March 2020 by 4,864.0 (p < 0.0001, CI = [3,077.1, 6,650.9]). In March 2020, there appeared to be a significant decrease in volume by 104,446.3 (p=0.003, CI = [-172,063.1, -36,829.5]), followed by a significant increase in the monthly trend of service volume (relative to the pre-COVID trend) of 20,660.7 per month (p=0.001, CI = [8,828.5, 32,493.0]). In December 2020, there appeared to be a significant decrease in service volume by 69,791.2 (p=0.012, CI = [-123,602.6, -15,979.7]). Compared to the period from March to November 2020, there was a decrease in the monthly trend of service volumes per month by 24,213.9 (p < 0.0001, CI = [-36,027.6, -12,400.2]). After March 2020, the total service volume increased at the rate of 25,524.7 per month (p < 0.0001, CI = [13,828.2, 37,221.2]). In contrast, the service volumes after December 2020 appeared to grow steadily and slowly at a rate of 1,310.8 per month (p=0.118, CI = [-348.8, 2970.3]). Conclusion Our study revealed that there has been a recovery and a further increase in breast imaging service volumes compared to prepandemic levels. The increase can be best explained by vaccination rollout, reopening of elective/nonemergency healthcare services, insurance coverage expansion, the decline in the US uninsured rate due to government interventions and policies, and the recovery of jobs with employer-provided medical insurance post-pandemic.
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Affiliation(s)
| | - Phil Ramis
- Radiology Partners Research Institute, El Segundo, California, USA
| | - Patrick Nielsen
- Radiology Partners Research Institute, El Segundo, California, USA
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3
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Zhang Z. Opinions on Remote and in-Person Breast Imaging Work: Survey Results from the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2024; 6:23-32. [PMID: 38243858 DOI: 10.1093/jbi/wbad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic accelerated trends in remote radiology work. We evaluated the opinions of Society of Breast Imaging (SBI) members regarding remote and in-person breast imaging work. METHODS An institutional review board-exempt anonymous survey was distributed to SBI members. Survey questions included demographics and opinions on remote and in-person work. RESULTS The response rate was 12% (307/2561). Overall, 79% of respondents preferred hybrid work, 16% preferred in-person work, and 5% preferred fully remote work. Only 34% of respondents had remote work in current practice. Screening mammograms (97%) and breast MRI (92%) were deemed most suitable for remote work. Most respondents believed barriers for remote work were inability to perform US (80%) and high monitor price (78%). Seventy-six percent of respondents believed remote work improves work-life balance and reduces burnout. Work model preferences were significantly associated with gender (P = .048) and perceived work-related impacts (P <.001). Women were more likely to prefer hybrid work than men (82% vs 73%). Compared to those who preferred in-person work, respondents who preferred hybrid work were more likely to believe remote work improves efficiency (89% vs 3%) and reduces burnout (88% vs 6%) while not negatively affecting career growth (88% vs 3%) or communication (87% vs 4%). CONCLUSION Hybrid work is the preferred model among SBI survey respondents. However, a minority have the option for remote work in current practice. Perceived benefits of remote work are efficiency and reduced burnout among breast imaging radiologists while not negatively affecting career growth or communication.
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Affiliation(s)
- Zi Zhang
- Department of Radiology, Jefferson Einstein Hospital, Philadelphia, PA, US
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Michalopoulou E, Pugalenthi PP, Darker I, Chen Y. A comparison of breast screening performance based on a standardised test, during and outside of the COVID-19 lockdown period. Eur J Radiol 2023; 168:111117. [PMID: 37778148 DOI: 10.1016/j.ejrad.2023.111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE In the UK, the COVID-19 pandemicand the resulting lockdown significantly impacted routine breast screening and led to reduced case volumes for breast screening readers. The aim of the study was to evaluate whether breast screening performance on a test-set based assessment scheme (PERFORMS) varied over time, in association with the lockdown period. METHOD In this retrospective study, performance data were obtained for all breast cancer screening readers in England who completed the PERFORMS schemes based on digital mammography (from 2015 to 2022). Cancer detection (sensitivity), correct return to screen (specificity) and the difference between the sensitivity and specificity were calculated for each breast screener in each PERFORMS scheme. RESULTS During the study period, 4906 readers participated in eight PERFORMS schemes. Both the cancer detection (H(7) = 775.56, p <.00001) and correct return to screen rate (H(7) = 401.13, p <.00001) varied significantly by scheme. The difference between cancer detection and correct return to screen rate in the scheme administered during the lockdown period was significantly higher than in all other schemes (p <.05, Bonferroni correction applied). CONCLUSIONS The performance of breast screeners on the PERFORMS test-set based assessment scheme which was administered during the lockdown period, was characterised by markedly high sensitivity and low specificity when compared to their performance on other tests taken pre-COVID and following the lockdown.
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Affiliation(s)
- Eleni Michalopoulou
- University of Nottingham, Translational Medical Sciences, School of Medicine, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
| | - Padma Priya Pugalenthi
- University of Nottingham, Translational Medical Sciences, School of Medicine, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom
| | - Iain Darker
- University of Nottingham, Translational Medical Sciences, School of Medicine, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom
| | - Yan Chen
- University of Nottingham, Translational Medical Sciences, School of Medicine, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom
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5
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Di Cosimo S, Ljevar S, Trama A, Bernasconi A, Lasalvia P, De Santis MC, Cappelletti V, Miceli R, Apolone G. Direct and indirect effects of COVID-19 on short-term mortality of breast cancer patients. Breast 2023; 71:60-62. [PMID: 37499377 PMCID: PMC10413129 DOI: 10.1016/j.breast.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
We studied the COVID-19 impact in newly-diagnosed breast cancer (7,349 patients in 2019, and 5,563 in 2020). In 2020 there were two diagnostic drops: -37.2% (March-May), -15.8% (October-December). Early-stage at presentation (76.4% vs. 74.4%, p = 0.0013), conserving surgery (71.0% vs. 67.0%, p < 0.0001), chemotherapy (86.2% vs. 53.4%, p < 0.0001), and radiotherapy (65.7% vs. 42.1%, p < 0.0001) decreased in 2020 compared to 2019. COVID-19 occurred in 250 patients (4.49%). The time-dependent COVID-19 effect was associated with mortality (multivariable Cox analysis HR [95% CI] 2.26 [1.35-3.74]; p = 0.0018). Survival within the year of diagnosis was 97.6% in 2020 and 98.3% in 2019; 30-day mortality was 1.13% in 2020 (1.07 in uninfected patients), and 0.61% in 2019. The year of diagnosis lost its prognostic relevance after adjusting for stage and treatment. These findings emphasize the critical role of continuity of care, which was disrupted during the pandemic, and underscore the need for policies minimizing treatment initiation delay in newly diagnosed breast cancer patients.
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Affiliation(s)
- Serena Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
| | - Silva Ljevar
- Biostatistics for Clinical Research Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Lasalvia
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Vera Cappelletti
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Rosalba Miceli
- Biostatistics for Clinical Research Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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6
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Dodelzon K, Grimm LJ, Plimpton SR, Markovic D, Milch HS. Ongoing Impact of COVID-19 on Breast Radiologists' Wellness. JOURNAL OF BREAST IMAGING 2023; 5:287-296. [PMID: 38416885 DOI: 10.1093/jbi/wbac100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Assess the ongoing impact of COVID-19 on mental well-being of breast radiologists nationwide two years after the start of the pandemic and compared to early in the pandemic. METHODS A 27-question survey was distributed from December 2021 to January 2022 to physician members of the Society of Breast Imaging. Psychological distress and anxiety scores were calculated, and factors associated with them were identified with a multivariate logistic model. RESULTS A total of 550 surveys were completed (23% response rate); the mean respondent age was 50 +/- 10 years. Fifty percent (265/526) of respondents reported two or more psychological distress symptoms, down from 58% in 2020 (P = 0.002), whereas 70% (362/526) of respondents reported increased anxiety, down from 82% in 2020 (P < 0.001). As in 2020, reporting financial strain and childcare adversely affecting job ability were associated with worse psychological distress scores (OR 3.6, 95% CI: 1.6-8.3, P = 0.02 and OR 6.0, 95% CI: 2.5-14.4, P = 0.002, respectively). Less time spent consulting, educating, and discussing results with patients was associated with higher psychological distress (OR 5.3, 95% CI: 2.1-13.2, P = 0.036) and anxiety (OR 6.4, 95% CI: 2.3-17.5, P < 0.001). Diminished research collaboration was associated with higher anxiety (OR 1.8, 95% CI: 1.1-2.9, P = 0.019). CONCLUSION The COVID-19 pandemic continues to cause mental health symptoms in breast radiologists, especially for those with pandemic-specific childcare needs and financial distress. Pandemic-related decreased opportunities to connect with patients and colleagues negatively impacts radiologists' mental health.
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Affiliation(s)
- Katerina Dodelzon
- Weill Cornell Medicine at New York-Presbyterian, Department of Radiology, New York, NY, USA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - S Reed Plimpton
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
| | - Daniela Markovic
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
| | - Hannah S Milch
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
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7
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Kozica‐Olenski SL, Ghelani DP, Boyle JA, Vincent AJ. The impact of
COVID
‐19 on a specialised menopause clinic: Changes in practice and women's experiences. Aust N Z J Obstet Gynaecol 2023. [DOI: 10.1111/ajo.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
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8
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Richman I, Tessier-Sherman B, Galusha D, Oladele CR, Wang K. Breast cancer screening during the COVID-19 pandemic: moving from disparities to health equity. J Natl Cancer Inst 2023; 115:139-145. [PMID: 36069622 PMCID: PMC9494402 DOI: 10.1093/jnci/djac172] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic created unprecedented disruptions to routine health care in the United States. Screening mammography, a cornerstone of breast cancer control and prevention, was completely halted in the spring of 2020, and screening programs have continued to face challenges with subsequent COVID-19 waves. Although screening mammography rates decreased for all women during the pandemic, a number of studies have now clearly documented that reductions in screening have been greater for some populations than others. Specifically, minoritized women have been screened at lower rates than White women across studies, although the specific patterns of disparity vary depending on the populations and communities studied. We posit that these disparities are likely due to a variety of structural and contextual factors, including the differential impact of COVID-19 on communities. We also outline key considerations for closing gaps in screening mammography. First, practices, health systems, and communities must measure screening mammography use to identify whether gaps exist and which populations are most affected. Second, we propose that strategies to close disparities in breast cancer screening must be multifaceted, targeting the health system or practice, but also structural factors at the policy level. Health disparities arise from a complex set of conditions, and multimodal solutions that address the complex, multifactorial conditions that lead to disparities may be more likely to succeed and are necessary for promoting health equity.
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Affiliation(s)
- Ilana Richman
- Correspondence to: Ilana Richman, MD, MHS, Department of Medicine, Yale School of Medicine, 367 Cedar St, Harkness Hall A, Room 301a, New Haven, CT 06510, USA (e-mail: )
| | - Baylah Tessier-Sherman
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Deron Galusha
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Carol R Oladele
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Karen Wang
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
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9
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Makurumidze G, Lu C, Babagbemi K. Addressing Disparities in Breast Cancer Screening: A Review. APPLIED RADIOLOGY 2022. [DOI: 10.37549/ar2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
| | - Connie Lu
- Weill Cornell Medicine New York Presbyterian
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10
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Gao Y, Heller SL. Health Disparity and Breast Cancer Outcomes in Asian Women. Radiographics 2022; 42:1912-1924. [PMID: 36053846 DOI: 10.1148/rg.220074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Health disparities in Asian women are complex and multifactorial. Screening attendance is low among Asian women, regardless of nativity or acculturation, and breast cancer detection has decreased by more than half in this population during the COVID-19 pandemic. The follow-up rate after abnormal screening results is similarly poor among Asian women compared with that among other groups, often resulting in a delay of cancer diagnosis. Yet the incidence of breast cancer in Asian women is increasing in the United States, with no such increase observed in other racial and ethnic groups in recent years. The age distribution of breast cancer in Asian women is distinct and peaks in younger women, underscoring the importance of early screening. The predilection for human epidermal growth factor receptor 2 (HER2)-enriched tumors may reflect the unique biologic characteristics of breast cancer among Asian subgroups, which are not well understood. Known biomarkers for breast cancer risk such as body mass index and mammographic density do not perform the same way in Asian women, as compared with other groups, owing to a lack of Asian population-specific data. Within that limitation, the association between body mass index and breast cancer is strongest in older Asian women, and the association between breast density and breast cancer is strongest in younger Asian women. There is an unmet need to improve breast cancer care in Asian women, a heterogeneous and growing population that is facing an increasing burden of breast cancer. An invited commentary by Leung is available online. ©RSNA, 2022.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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11
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Grimm LJ, Lee C, Rosenberg RD, Burleson J, Simanowith M, Fruscello T, Pelzl CE, Friedewald SM, Moy L, Zuley ML. Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database. J Am Coll Radiol 2022; 19:919-934. [PMID: 35690079 PMCID: PMC9174535 DOI: 10.1016/j.jacr.2022.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
Abstract
Purpose The aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic. Methods Screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods. Results In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers. Conclusions COVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, Durham, North Carolina; Vice Chair, National Mammography Database.
| | - Cindy Lee
- NYU Langone Health, New York, New York
| | - Robert D Rosenberg
- Radiology Associates of Albuquerque, Albuquerque, New Mexico; Chair, National Mammography Database
| | - Judy Burleson
- Vice President, Quality Programs, American College of Radiology, Reston, Virginia
| | - Michael Simanowith
- Director, Quality Registries, American College of Radiology, Reston, Virginia
| | | | - Casey E Pelzl
- American College of Radiology, Harvey L. Neimann Health Institute, Reston, Virginia
| | - Sarah M Friedewald
- Vice Chair, Women's Imaging, Chief of Breast Imaging, Northwestern Medicine, Chicago, Illinois
| | - Linda Moy
- NYU Langone Health, New York, New York
| | - Margarita L Zuley
- Chief of Breast Imaging, Vice Chair of Quality Assurance and Strategic Development, University of Pittsburgh, Pittsburgh, Pennsylvania; Chair, National Radiology Data Registry
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12
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Smith RE, Sprague B, Henderson LM, Kerlikowske K, Miglioretti DL, Buist DSM, Wernli KJ, Onega T, Schifferdecker K, Jackson-Nefertiti G, Johnson D, Budesky J, Tosteson ANA. Breast Density Knowledge in a Screening Mammography Population Exposed to Density Notification. J Am Coll Radiol 2022; 19:615-624. [PMID: 35341697 PMCID: PMC9119699 DOI: 10.1016/j.jacr.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Women are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening. METHODS From December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as "ever-dense" if heterogeneously or extremely dense within the past 5 years or "never-dense" otherwise, knowledge of dense breast implications, and feelings about future screening. RESULTS Survey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P = .003, P = .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts. DISCUSSION Standardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.
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Affiliation(s)
- Rebecca E Smith
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire.
| | - Brian Sprague
- Associate Professor of Surgery, Director of the Vermont Breast Cancer Surveillance System, and Senior Epidemiologist at the Vermont Center on Behavior and Health, Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Louise M Henderson
- Professor of Radiology, Director of the Carolina Mammography Registry, and Director of the North Carolina Lung Screening Registry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Professor of Medicine and Epidemiology and Biostatistics, Co-Director of the Women's Clinic, and Director of the Women's Health Fellowship at the San Francisco Veterans Affairs Medical Center, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Diana L Miglioretti
- Dean's Professor and Division Chief of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA; Principal Investigator of the Breast Cancer Surveillance Consortium (BCSC) Administrative Core, and Affiliate Scientific Investigator, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Diana S M Buist
- Affiliate Professor of Epidemiology, Affiliate Professor of Health Systems and Population Health, and Director of Research and Strategic Partnerships, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Karen J Wernli
- Affiliate Associate Professor of Epidemiology and Affiliate Associate Professor of Health Systems and Population Health, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Tracy Onega
- Jon M. and Karen Huntsman Presidential Professor in Cancer Research, Senior Director of Population Sciences, and Professor of Population Health Sciences, Department of Population Health Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karen Schifferdecker
- Associate Professor, and Director of the Center for Program Design and Evaluation, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | | | - Dianne Johnson
- Department of Public Health Sciences, University of California, Davis, California
| | - Jill Budesky
- Department of Public Health Sciences, University of California, Davis, California
| | - Anna N A Tosteson
- James J Carroll Professor, The Dartmouth Institute for Health Policy and Clinical Practice, and Departments of Medicine and of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; and Associate Director for Population Sciences, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
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Trivedi U, Omofoye TS, Marquez C, Sullivan CR, Benson DM, Whitman GJ. Mobile Mammography Services and Underserved Women. Diagnostics (Basel) 2022; 12:902. [PMID: 35453950 PMCID: PMC9032638 DOI: 10.3390/diagnostics12040902] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023] Open
Abstract
Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.
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Affiliation(s)
- Usha Trivedi
- Rutgers New Jersey Medical School, 187 S W Orange, Newark, NJ 07103, USA;
| | - Toma S. Omofoye
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Cindy Marquez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Callie R. Sullivan
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Diane M. Benson
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, 7007 Bertner Avenue, Unit 1677, Houston, TX 77030, USA;
| | - Gary J. Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
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15
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Covid-19 Pandemic Impact on Breast Cancer Detection-The Major Effects Over an Early Diagnosis. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:494-500. [PMID: 35444824 PMCID: PMC8987474 DOI: 10.12865/chsj.47.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/18/2021] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic has disrupted medical care systems, by decreasing patient addressability to outpatient care. The main objective of this study was to compare the patient’s addressability to breast imaging techniques for diagnosis, and follow-up in the Clinical Emergency County Hospital of Craiova, Romania. We selected the mammographies performed over a period of 4 years (2018-2021) in our clinic. We divided the patients into four groups, one for each year (2018, 2019, 2020, 2021). Furtherly, we merged the data into two groups, one group for the pre-pandemic years (2018 and 2019) and one for the pandemic years (2020 and 2021). In our clinic, the number of mammographies plummeted to 0 during the month of April 2020 due to the lockdown and closure of non-urgent outpatient services in hospitals treating COVID-19 patients, and slowly creeped to 11 in the month of May and peaked to 160 in July (for the rest of the year). There was a huge difference regarding the patient’s addressability to mammography immediately after the lockdown, with a 95.2% less addressability compared to the pre-pandemic period (May 2020 compared to May 2018). As an overall, by comparing both pre-pandemic years included in the study with the pandemic years, we obtained an addressability reduced with 37.3% suggesting the possible future delays in diagnosing breast tumors.
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