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Is it Safe to Get a Mammogram or Breast MRI During the Pandemic?

November 09, 2020

Is it Safe to Get a Mammogram or Breast MRI During the Pandemic?

by Deanna Attai, MD

Earlier this year, spread of the SARS-CoV-2 novel coronavirus across the world prompted the World Health Organization to declare a global pandemic in March.1 As this was an unknown virus, experts were unsure of its severity. In addition, shortage of personal protective equipment (PPE) and lack of widespread testing were factors that led national organizations to recommend that patients forgo cancer screening tests such as mammograms and colonoscopy to limit exposure and conserve resources.2 Reports from countries that were affected prior to the U.S. suggested poor outcomes in patients with COVID-19 who underwent surgery or cancer treatment. At the same time, many hospitals reported shortages of PPE, ventilators and intensive care unit beds and medications required for critically ill patients. In response, the American College of Surgeons and other organizations recommended that hospitals cancel most elective surgeries, including those for cancer.3

Initial response to COVID-19

In March, many healthcare experts felt that the many guidelines and restrictions that went into effect would only be for a few months. In the U.S., we are now in our eighth month of masking and social distancing. Over 238,000 have died, and COVID-19 cases are increasing in some areas. While surgeries have resumed in many communities, concerns have been raised that we will see an increase in cancer-related deaths over the next few years due to delays in screening exams4 as well as loss of health insurance due to job loss and economic hardship.5

Recent updates

Some recent studies have demonstrated the toll that the COVID-19 pandemic has taken on cancer screening. In May 2020, the electronic health record vendor EPIC noted that cervical, breast and colon cancer screenings declined between 86% - 94% in March 2020 compared with prior years.6 A follow up report noted that screenings have begun to rise, but levels in June 2020 remain between 29% - 36% lower than the same period in 2019.7 The American Society of Clinical Oncology noted that approximately two-thirds of U.S. adults surveyed have either delayed or skipped their cancer screening exams.8

The American College of Radiology and other organizations are recommending that patients resume breast cancer screening, and they have outlined the precautions that facilities are taking to limit exposure.9 However, many patients still have concerns regarding the safety of medical tests that require them to be around others. There is simply no easy answer and individualization and education are key. The American Cancer Society notes that restarting screening requires careful consideration of both the risks and benefits of screening and ensuring the safety of patients as well as healthcare providers. They note that decisions to resume screening should be individualized for each patient, and may vary depending on COVID-19 cases and other factors that are unique to each community.10

Tips for patients

So, what should an individual patient do? First, of course, is to discuss your personal cancer risk with your medical provider. It is important to understand the risks and benefits of screening in the context of your general health and risk of complications related to possible COVID-19 exposure and infection. In addition, your local physician will likely have insight into the severity of the pandemic in your area and steps that local facilities may be taking to protect patients and staff from infection. It is also recommended to contact the imaging facilities prior to your appointment to better understand their screening and distancing policies. The American Cancer Society also stresses that screening is for those without any symptoms – those with concerning findings should not delay care. The Komen Foundation also stresses that delaying breast cancer screening means that individuals need to know their “normal” as well as understand the types of breast changes and warning signs they may indicate cancer. As with all aspects of medical and cancer care, there is no one-size-fits-all answer. Partner with your healthcare team to determine the best approach for you.

References

  1. STAT News: WHO Declares the Coronavirus Outbreak A Pandemic
  2. American Society of Breast Surgeons/American College of Radiology: Joint Statement on Breast Screening
  3. American College of Surgeons COVID-19: Recommendations for Management of Elective Surgical Procedures: Recommendations for Management of Elective Surgical Procedures
  4. ASCO Post:  How Delays in Screening and Early Cancer Diagnosis Amid the COVID-19 Pandemic May Result in Increased Cancer Mortality: A Conversation With NCI Director Norman E. ‘Ned’ Sharpless, MD
  5. UCLA Health: Doctors Fear Mammography Cancellations During Pandemic Could Lead to Poorer Breast Cancer Outcomes
  6. STAT News: Routine Cancer Screenings Have Plummeted During the Pandemic, Medical Records Data Show
  7. EPIC Health Research Network: Delayed Cancer Screenings—A Second Look
  8. American Society of Clinical Oncology: National Survey Reveals Racial Differences in Perceptions of Inequities in Health Care and Concerning Delays in Cancer Screenings Amid COVID-19
  9. American College of Radiology: "Return to Mammography Care" Toolkit
  10. American Cancer Society: Cancer Screening During the COVID-19 Pandemic
  11. Komen Connection: Delaying Mammograms During COVID-19 Means Women Must Know Their Normal, Warning Signs

 

Dr. Deanna Attai is an Assistant Clinical Professor of Surgery at the David Geffen School of Medicine at UCLA and a past-president of the American Society of Breast Surgeons. A native of New York, she received her undergraduate degree from Vassar College. She is a graduate of the Georgetown University School of Medicine and completed her general surgery residency at the Georgetown University Hospital. Her free time is spent growing organic vegetables and with her 2 rescue calico catsDr. Attai is a member of FORCE's Scientific Advisory Board. Her recent webinar, "How the COVID-19 pandemic affects breast cancer diagnosis and surgery" is available for on-demand viewing. You can follow Dr. Attai's blog, here.

Posted in: Risk Management, COVID19
Tags: Screening And Prevention

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