ABSTRACT
Background Digital breast tomosynthesis (DBT), also called 3D mammography, was first approved by the Federal Drug Administration in 2011. The goal of 3D mammography is to improve accuracy compared to 2D digital mammography (DM), by increasing sensitivity and decreasing recall rates. To capture the broad utilization of DBT in populations receiving both screening and diagnostic imaging, this analysis investigates DBT usage over time in a longitudinal sample from 2016 through 2020 for adult women ranging from 18-74 years of age. Methods Retrospective analyses were conducted using de-identified administrative claims data from a large national U.S. health insurer. The study cohort consisted of women who were continuously enrolled in a commercial or Medicare Advantage plan from 1/2016 to 12/2020 and aged 18 to 74 years old as of 2016. All procedures were identified based on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. For each study year, receipt of breast cancer screening with DM (S-DM) or including DBT (S-DBT) were captured. Receipt of DM and DBT not specified for screening based on CPT code descriptions were categorized as diagnostic, D-DM and D-DBT respectively. Women that received both DBT and DM in the same year were included in the DBT group. In addition, women who received MRI and ultrasound were also captured. Rates of each procedure by study year, insurance type, and age categories that align with recommended screening guidelines (<40 years old, 40-49 years old and 50-74 years old) were examined. Results Approximately 3.8 million women met study criteria;85% were commercially insured and 15% were Medicare Advantage. Table 1 shows rates of adult women who received mammography, MRI and ultrasound over the study period. About 74% of study subjects receiving screening were 50-74 years old at the start of the study period, 25% were 40-49 years and 1% were under 40 years old. In 2020, there were fewer women (3%-13%) receiving imaging procedures compared to counts in 2019. During the 5-year study period, there was a 3.5-fold increase in the number of women who received S-DBT. In 2016, 23% of women who received a screening mammogram received S-DBT and by 2020, this percent increased to 82%. The percent of women who received a diagnostic mammogram using D-DBT compared to D-DM also increased overtime;29% of women received a D-DBT in 2016 and this increased to 77% in 2020. The number of women with receipt of ultrasound and MRI were similar in each study year. The percent diagnostic/screening tests (including DBT and DM) were in the range of 18.5%-20.2% each year. Conclusion Among this cohort of women who were continuously enrolled in the health plan throughout the 5-year study period, this analysis shows that screening and diagnostic DBT utilization rates increased from 2016 to 2020 while DM screening and diagnostic imaging utilization concomitantly decreased. The percentages of women that received S-DBT and D-DBT were highest in 2020, even though 8%-13% fewer women had evidence of mammography than in 2019, which is largely due to COVID-19 related healthcare service disruptions. The rate of diagnostic tests as a percent of screening tests did not decrease with the adoption of DBT. Further analyses investigating rates of follow-up procedures and downstream costs are warranted.
ABSTRACT
Background: The impact of active cancer on susceptibility to coronavirus disease 2019 (COVID-19) remains controversial. This study leverages the infrastructure across the University of California (UC) Cancer Consortium, pooling electronic health record (EHR) data to assess the relationship between active cancer diagnoses (n=151,392) and COVID-19 positivity. Methods: In this cohort study, patients with COVID-19 test results and active cancer diagnoses were identified from the UC Health System COVID Research Data Set (CORDS). This data set collects COVID-19 test results from the 5 academic medical centers in the UC Health System and their NCI-designated Comprehensive Cancer Centers. COVID-19 test results were identified by Logical Observation Identifiers Names and Codes (LOINC). Active cancer was defined as an EHR-based malignant diagnosis within 9 months of testing, irrespective of active therapy. Total daily positivity rates were aggregated, and overall rates were compared across patients with and without active cancer using the Pearson’s Chi-squared test. Results: We identified 1,032,588 COVID-19 tests from March 3, 2020 to April 15, 2021, with 151,392 tests (14.7%) associated with an active cancer diagnosis. Monthly trends in positivity rates throughout the pandemic were similar between patients with and without cancer (Table). Overall positivity was lower in patients with active cancer (2.0% versus 4.4%;p<0.001). This was consistent across individual UC sites. [Formula presented] Conclusions: COVID-19 positivity rates were not increased for individuals with active cancer diagnoses in the UC Cancer Consortium. A lower positivity rate amongst cancer patients may be due to demographic, behavioral, occupational or environmental factors, as well as greater asymptomatic testing of cancer patients at some UC sites. Interactions with local prevalence and patient and cancer characteristics will be presented. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.