Experience of a single healthcare system with screening mammography before and after COVID-19 shutdown.

PURPOSE: To evaluate COVID-19's longitudinal impact on screening mammography volume trends. METHODS: HIPAA-compliant, IRB-approved, single institution, retrospective study of screening mammogram volumes before (10/21/2016-3/16/2020) and greater than two years after (6/17/2020-11/30/2022) a state-mandated COVID-19 shutdown (3/17/2020-6/16/2020) were reviewed. A segmented quasi-poisson linear regression model adjusting for seasonality and network and regional population growth compared volume trends before and after the shutdown of each variable: age, race, language, financial source, risk factor for severe COVID-19, and examination location. RESULTS: Adjusted model demonstrated an overall increase of 65 screening mammograms per month before versus a persistent decrease of 5 mammograms per month for >2 years after the shutdown (p < 0.0001). In subgroup analysis, downward volume trends were noted in all age groups <70 years (age < 50: +9/month before vs. -7/month after shutdown; age 50-60: +17 vs. -7; and age 60-70: +21 vs. -2; all p < 0.001), those identifying as White (+55 vs. -8, p < 0.0001) and Black (+4 vs. +1, p = 0.009), all financial sources (Medicare: +22 vs. -3, p < 0.0001; Medicaid: +5 vs. +2, p = 0.006; private insurance/self-pay: +38 vs. -4, p < 0.0001), women with at least one risk factor for severe COVID-19 (+30 vs. -48, p < 0.0001), and screening mammograms performed at a hospital-based location (+48 vs. -14, p = 0.0001). CONCLUSION: The screening mammogram volume trend more than two years after the COVID-19 shutdown has continued to decline for most patient populations. Findings highlight the need to identify additional areas for education and outreach.

Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database.

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.

Women's Experience With Screening Mammography During the COVID-19 Pandemic: A Multi-Institutional Prospective Survey Study

Objective Evaluate women's anxiety and experience undergoing screening mammography during the COVID-19 pandemic. Methods An IRB-approved anonymous survey was administered to women receiving screening mammography across six sites in the U.S. and Singapore from October 7, 2020, to March 11, 2021. Using a 1-5 Likert scale, women rated their pre- and post-visit anxiety regarding having their mammogram during the COVID-19 pandemic, importance of observed COVID-19 precautions, and personal risk factors for breast cancer and severe COVID-19 illness. Post-visit change in anxiety was evaluated. Multivariable logistic regression was used to test associations of pre-visit anxiety with breast cancer and COVID-19 risk factors. Results In total, 1086 women completed the survey. Of these, 59% (630/1061) had >1 breast cancer risk factor;27% (282/1060) had >1 COVID-19 risk factors. Forty-two percent (445/1065) experienced pre-visit anxiety. Pre-visit anxiety was independently associated with risk factors for severe COVID-19 (OR for >2 vs 0 risk factors: 2.04, 95% confidence interval [CI]: 1.11-3.76) and breast cancer (OR for >2 vs 0 risk factors: 1.71, 95% CI: 1.17-2.50), after adjusting for age and site. Twenty-six percent (272/1065) of women reported post-visit anxiety, an absolute 16% decrease from pre-visit anxiety (95% CI: 14%-19%, P < 0.001). Provider masking (941/1075, 88%) and physical distancing (861/1085, 79%) were rated as the most important precautions. Conclusion Pre-visit anxiety was associated with COVID-19 or breast cancer risk factors and declined significantly after screening mammography. Provider masking and physical distancing were rated the most important precautions implemented by imaging clinics.

Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + .

BACKGROUND: Routine screening mammography at two-year intervals is widely recommended for the prevention and early detection of breast cancer for women who are 50 years + . Racial and other sociodemographic inequities in routine cancer screening are well-documented, but less is known about how these long-standing inequities were impacted by the disruption in health services during the COVID-19 pandemic. Early in the pandemic, cancer screening and other prevention services were suspended or delayed, and these disruptions may have had to disproportionate impact on some sociodemographic groups. We tested the hypothesis that inequities in screening mammography widened during the pandemic. METHODS: A secondary analysis of patient data from a large state-wide, non-profit healthcare system in Washington State. Analyses were based on two mutually exclusive cohorts of women 50 years or older. The first cohort (n = 18,197) were those women screened in 2017 who would have been due for repeat screening in 2019 (prior to the pandemic's onset). The second cohort (n = 16,391) were women screened in 2018 due in 2020. Explanatory variables were obtained from patient records and included race/ethnicity, age, rural or urban residence, and insurance type. Multivariable logistic regression models estimated odds of two-year screening for each cohort separately. Combining both cohorts, interaction models were used to test for differences in inequities before and during the pandemic. RESULTS: Significant sociodemographic differences in screening were confirmed during the pandemic, but these were similar to those that existed prior. Based on interaction models, women using Medicaid insurance and of Asian race experienced significantly steeper declines in screening than privately insured and white women (Odds ratios [95% CI] of 0.74 [0.58-0.95] and 0.76 [0.59-0.97] for Medicaid and Asian race, respectively). All other sociodemographic inequities in screening during 2020 were not significantly different from those in 2019. CONCLUSIONS: Our findings confirm inequities for screening mammograms during the first year of the COVID-19 pandemic and provide evidence that these largely reflect the inequities in screening that were present before the pandemic. Policies and interventions to tackle long-standing inequities in use of preventive services may help ensure continuity of care for all, but especially for racial and ethnic minorities and the socioeconomically disadvantaged.

Limiting Screening Mammography Recalls for Vaccine-Induced Adenopathy, a Single Institution Experience.

RATIONALE AND OBJECTIVES: Reported incidence of vaccine-induced adenopathy varies widely, with higher estimates in early reports and small series. Objective was to evaluate a large sample of vaccinated patients undergoing screening mammography, to determine callback rates associated with vaccine-induced adenopathy and their outcomes. MATERIALS AND METHODS: Single-institution retrospective review of patients who received at least 1 dose of a COVID-19 vaccine prior to presentation for screening mammography from January 15 through May 31, 2021. Patient-related vaccination information (dose, brand, arm, date) was obtained by mammography technologists and available for interpreting radiologists. Patients recalled for axillary adenopathy were included; other causes for recall were excluded. Follow-up imaging and outcomes were tracked. Wilcoxon rank-sum test, Fisher exact test, multivariable logistic regression modeling, and receiver operating characteristic curve analyses were utilized. All tests were two-sided; p < 0.05 considered statistically significant. RESULTS: Total of 2304 vaccinated patients underwent screening mammography; 24 (1.0%) recalled for ipsilateral adenopathy. There was no significant difference in presence of adenopathy associated with patient age, dose, or brand of vaccine. Presence of adenopathy significantly decreased as days from vaccination increased (p < 0.001). Receiver operating characteristic curve suggested 28.5 days as the best cutoff point to distinguish presence or absence of adenopathy on mammogram. Of 24 callbacks, 13 (54.2%) had benign results, 2 (8.3%) are still undergoing surveillance, and 9 (37.5%) are overdue for subsequent follow-ups. No cases resulted in biopsy or malignancy. CONCLUSION: Low recall rates related to vaccine-induced adenopathy are achievable and can limit unnecessary workups, improve access, and promote flexible timing of vaccinations and screening exams.

Identifying Patients at Risk of Delayed Breast Imaging Due to the COVID-19 Pandemic.

OBJECTIVE: Epidemiological models predict worse cancer outcomes due to COVID-19 pandemic-related delays in cancer surveillance and treatment. This study evaluated patient demographic factors associated with delayed breast imaging or procedure appointments due to COVID-19. METHODS: Patients attending a breast imaging or procedure appointment at the Pennsylvania Hospital Breast Center from December 28, 2020 to January 31, 2021 were asked to complete a voluntary and anonymous survey on the impact of COVID-19. Chi-squared and two-sample t-tests were used to analyze correlations between having a delayed appointment and various demographic variables. RESULTS: Five hundred seventy patients completed the survey. Participants were more likely to have delayed a breast imaging or procedure appointment if they were younger (53.9 versus 57.4 years old, p=0.014), had more total household residents (2.7 versus 2.2, p=0.019) or children (0.8 versus 0.4, p=0.016), personally had COVID-19 (p=0.04), or personally had to quarantine (p<0.01). Race, ethnicity, education, income level, and marital status were not found to statistically significantly correlate with having a delayed appointment. CONCLUSION: This study found that younger age, a greater number of residents and children in the household, and having a personal history of COVID-19 infection or quarantining were factors significantly correlated with delaying a breast imaging or procedure appointment. As radiology practices prepare to mitigate the impact of COVID-19 on screening practices and cancer outcomes, these findings may help imaging centers refine patient outreach efforts and policy accommodations to protect the most vulnerable populations.

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

PURPOSE: In order to facilitate targeted outreach, we sought to identify patient populations with a lower likelihood of returning for breast cancer screening after COVID-19-related imaging center closures. METHODS: Weekly total screening mammograms performed throughout 2019 (baseline year) and 2020 (COVID-19-impacted year) were compared. Demographic and clinical characteristics, including age, race, ethnicity, breast density, breast cancer history, insurance status, imaging facility type used, and need for interpreter, were compared between patients imaged from March 16 to October 31 in 2019 (baseline cohort) and 2020 (COVID-19-impacted cohort). Census data and an online map service were used to impute socioeconomic variables and calculate travel times for each patient. Logistic regression was used to identify patient characteristics associated with a lower likelihood of returning for screening after COVID-19-related closures. RESULTS: The year-over-year cumulative difference in screening mammogram volumes peaked in week 21, with 2962 fewer exams in the COVID-19-impacted year. By week 47, this deficit had reduced by 49.4% to 1498. A lower likelihood of returning for screening after COVID-19-related closures was independently associated with younger age (odds ratio (OR) 0.78, p < 0.001), residence in a higher poverty area (OR 0.991, p = 0.014), lack of health insurance (OR 0.65, p = 0.007), need for an interpreter (OR 0.68, p = 0.029), longer travel time (OR 0.998, p < 0.001), and utilization of mobile mammography services (OR 0.27, p < 0.001). CONCLUSION: Several patient factors are associated with a lower likelihood of returning for screening mammography after COVID-19-related closures. Knowledge of these factors can guide targeted outreach to vulnerable patients to facilitate breast cancer screening.