Cancer screenings are integral to the care paradigm for breast cancer. According to the American Cancer Society's Cancer Prevention & Early Detection Facts & Figures 2019-2020, screening mammograms have helped reduce breast cancer deaths by about 20 percent due to early detection and treatment. The report also notes that an estimated five breast cancers are detected for every 1,000 screening mammograms.
But amid the global COVID-19 pandemic, they may not be a good idea, experts say. In fact, leaders in the field such as Harold J. Burstein, MD, PhD, of the Dana-Farber Cancer Institute, and George Sledge, Jr., MD, of Stanford University Medical Center, took to Twitter on March 16 to advocate that clinicians delay screening mammography (https://twitter.com/DrHBurstein/status/1239534281275379713).
Just 2 days later, on March 18, Susan G. Komen, the world's leading nonprofit breast cancer organization, issued a statement recommending “healthy women of average risk delay routine breast cancer screening until later this year.”
“Postponement makes sense for most screens because 1) the timing of screenings is often arbitrary, and 2) it could reduce infection risk for both patients and providers,” according to Sledge.
With the health care systems straining with the care of COVID-19 patients, “we all share a responsibility to help stem the spread and to support our health care providers as they focus on those most in need of care,” Sledge emphasized in the Komen press release.
Screening Do's and Don'ts
Routine screening can be delayed, in part, because annual screens aren't necessarily crucial in the first place, according to Burstein.
“Remember that around the world, most countries recommend screening mammograms every 1-2 years, anyway, and not annually like [the] U.S. So, deferring by a few month(s) should not be of clinical consequence,” he said in a March 16 tweet (https://twitter.com/DrHBurstein/status/1239580715819270149).
That being said, screening remains an integral clinical step for women experiencing warning signs of breast cancer.
“In breast cancer, we characterize mammograms as screening or diagnostic, the latter for symptoms or physical exam changes. Diagnostic mammograms should still be pursued with vigor,” Sledge clarified.
With the suspension of non-essential clinical visits, patient education on the early warning signs of breast cancer is a must, according to the Komen press release. Signs of breast cancer are different for everyone, so patients should remain diligent with self-breast exams and understand what is normal for them—and recognize when something changes. If patients notice changes to the look or feel of the breast, they should contact their health care provider.
“How long suspensions remain in place is a function of the length and severity of the outbreak,” Sledge noted. No one knows how long the pandemic will disrupt health visits, although most agree it's here for the next few months, at least.
The situation is rapidly changing, escalating from a “public health emergency of international concern” on January 30 to a global pandemic as of March 11. Health care providers should recommend postponing screenings for the foreseeable future—and prepare for the consequences once the pandemic subsides.
“A prolonged delay [in screening] will delay diagnosis of cancer for some patients,” admitted Sledge. “From a health care system standpoint, we will be kicking the can down the road, which will add future burdens to providers.”
He provided the example of a patient with early-stage breast cancer, with doubling times that range between 3 and 12 months, according to the medical literature. “A brief delay versus a long delay could result in significant differences in size and stage at diagnosis,” he explained.
A recent literature review found delays in treatment for breast cancer have less of an impact than often thought; still, the longer wait nonetheless impacts outcomes (Ann Surg Oncol 2018; doi: 10.1245/s10434-018-6615-2). The review found surgery within 90 days of diagnosis and 120 days for chemotherapy led to the best outcomes as reported in the literature—times that very well could be impacted by delayed screening due to COVID-19.
But for right now, the risks simply outweigh the benefits when it comes to breast cancer screenings during this COVID-19 pandemic. Until the pandemic is under control, the safest decision for everyone is to avoid contact to reduce the risk of spreading the virus and ease the health care burden.
Rebecca Wilson is a contributing writer.