ABSTRACT
Introduction: Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in women in the United States. The significant advances in care over the last decades are largely attributable to early detection and treatment. The pre-COVID-19 pandemic 5year survival rate of breast cancer was in the range of 90%, however, there has been public concern that the pandemic has led to delayed diagnosis. The objective of this study was to determine if patients diagnosed during the pandemic had more advanced breast cancer at presentation compared to those diagnosed prior. Method(s): This is a retrospective study of patients with an ICD code for Breast Cancer seen within the University of Texas Health San Antonio MD Anderson Cancer Center between 1/1/2018 and 12/31/2021. Data abstractors collected information on gender, age, race, ethnicity, funding, screening mammogram dates, date of cancer diagnosis, stage at diagnosis, and treatment. Those diagnosed before 1/1/2018 or that received initial treatment outside our institution were excluded from the analysis. Pearson's Chi-squared and logistic regression tests were used to determine the relationship between time and stage at diagnosis. The timeline was divided into three periods: from 01/01/2018 to 03/31/2020 as the pre-COVID era, from 04/01/2020 to 12/31/2020 as the lockdown period, and from 01/01/2021 to the present as the post-vaccine era. Result(s): A total of 696 patients with breast cancer were included. There was a significant statistical difference between the cancer stage at diagnosis in the pre-COVID-19 era compared to the lockdown period and the post-vaccine era (p= 0.003, table 1). Therefore, patients diagnosed after the beginning of lockdown were more likely to have more advanced cancer as time progressed. The odds ratio for Tis stage was 0.38 (95% CI: 0.23-0.60;P < 0.001) in the post-vaccine era compared to the pre-COVID era. The OR for Tis stage was not statistically significant (OR, 0.68;95% CI: 0.421.10;P < 0.12) when comparing the lockdown period to the pre-COVID era. Conclusion(s): Patients diagnosed with breast cancer in the COVID-19 pandemic were more likely to present with more advanced disease at diagnosis compared to those diagnosed in the pre-COVID19 era confirming our hypothesis. The OR of presenting with Tis disease when diagnosed during the post-vaccine compared to the pre-COVID-19 era was 0.38, however, this was not seen when comparing the lockdown period to the pre-pandemic era. We believe this difference was not significant because delays in cancer care may take months to years to take full effect. (Table Presented).
ABSTRACT
Background: Hispanics are among the most significant minorities in the United States, and assessing their health needs is vital in formulating health policies. The social, environmental, and biological background affect their morbidity and mortality, with cancer being the leading cause of mortality in Hispanics. Although implementing the Affordable Care Act improved access to health care, disparities and challenges in Hispanics' access to health care remain. (1) In our study, we are trying to assess the COVID-19 pandemic implications on the socioeconomic status of Hispanics with newly diagnosed breast cancer and how that is affecting their outcome. Method(s): This is a retrospective study demonstrating the nature of breast cancer screening, diagnosis, and management during COVID-19 lockdown and post-vaccine compared to the preCOVID-19 era. The restrospective review was conducted at Mays Cancer Center in San Antonio, IRB approved by UT Health San Antonio. The data were ed from the medical record system (EPIC). Pearson's Chi-squared and logistic regression tests were used to determine the relationship between time and stage at diagnosis and association with funding status Result: 696 subjects with newly diagnosed breast cancer were identified and divided into three cohorts: Cohort A: 264 pts in a pre-covid era: From 2018-February 2020, Cohort B: 171 patients during the covid-19 lockdown, and Cohort C: from April 2020-Dec-2020 with 261 patients in the post-vaccine era. A higher percentage of patients had Tis identified in Cohort A (26%) compared to Cohort B (19%) and Cohort C(12%) (p0.003). These numbers have changed to an increasing percentage of patients with T1 or T2. N0 or N1in Cohort B (62%) and Chohort C (68%), p0.003). Presentation of locally advanced (T3/T4 with any N) and metastatic disease remained relatively similar in all cohorts, with more metastatic cases at presentation in Cohort A (p0.003). Many patients of Hispanic ethnicity (OR 1.47, p0.1) were not funded by commercial insurance or Medicare. (OR 2.33, 95% CI 1.43, 3.77, p< 0.001). A high proportion of Hispanic ethnicity in post covid era (cohort B and C) OR 1.78, 95% CI (1.16,2.79) (p0.009) required neoadjuvant chemotherapy suggesting more advanced and possibly aggressive cancer histology. We observed that unfunded patients are less likely to have hormonal receptor-positive breast cancer (p0.001). Conclusion(s): Population health is likely affected by socioeconomic status, which eventually affects their health care. In a minority Hispanic population, low average income and educational attainment are likely the obstacles to getting timely appropriate health.(2) A higher proportion of Hispanic patients were not insured when compared to non-Hispanics leading possibly to more advanced and aggressive histologies at presentation. (Table Presented).
ABSTRACT
Background In breast cancer, prognosis is marked by histology and stage at diagnosis. Patients presenting with HER-2 positive or triple negative breast (TNBC) often have a worse prognosis. Early detection of breast cancer is mainly based on yearly screening mammograms, which were disrupted during the lockdown stages of the COVID-19 pandemic. In general, underserved populations, especially the Hispanic population often lack access to preventive care due to lack of funding causing delays in access to timely care. The COVID-19 pandemic caused many patients to miss their annual mammogram screening due to lockdown causing subsequent presentation of more advanced cancer. We, therefore, hypothesized that more patients were diagnosed with advanced cancer after lockdown and worse histology in the Hispanic population compared to the non-Hispanic population of San Antonio, Texas. Methods We identified 3 cohorts retrospectively using chart review: Pre-covid-19 era was defined between 2018 to March 2020. Lockdown is defined as a period between April 2020 to December 2020 followed by the post-vaccine era from January 1st 2021 to 2022. Pearson's Chi-squared and logistic regression tests were used to determine the relationship between time, histology at diagnosis and ethnicity. Results More Hispanic patients were found to present with HER2+ disease (OR: 1.65. p-value .047) compared to non-Hispanic women. When looking at presentation of HER2+ disease in the pre-covid-19 era, there was a 15.11% increase in the presentation of HER2+ disease in the post-vaccine era. When looking at the presentation of TNBC disease in women, there was not a significant correlation seen in the lockdown or post-vaccine period in Hispanic compared non-Hispanic women. Other factors such as funding status were associated with TNBC at presentation independently of ethnicity. In the lockdown era, the number of newly diagnosed breast cancer patients reached an all-time low and during the post-vaccine era, the patient numbers are back to the pre-covid era. Conclusion Ethnicity in part played a role in the number of patients presenting with more aggressive histology such as TNBC and Her 2 positive breast cancer in the post-vaccine era. These findings may be secondary to fact that certain ethnic groups are more likely to miss preventive screenings and the covid 19 pandemic lockdown exacerbated this problem. Diagnosis of advance cancer can further deter patients from seeking care due to socioeconomic factors and possibly increase mortality in these populations. These findings suggest that there seems to be a correlation between race and presentation of more aggressive histology caused by the effects of the pandemic in cancer care affecting minorities.