Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Radiology and University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.
Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.
Prev Med. 2021 Oct;151:106540. doi: 10.1016/j.ypmed.2021.106540. Epub 2021 Jun 30.
The COVID-19 pandemic disrupted breast cancer screening and diagnostic imaging in the United States. We sought to evaluate how medical facilities prioritized breast imaging services during periods of reduced capacity or upon re-opening after closures. In fall 2020, we surveyed 77 breast imaging facilities within the Breast Cancer Surveillance Consortium in the United States. The survey ascertained the pandemic's impact on clinical practices during March-September 2020. Nearly all facilities (97%) reported closing or operating at reduced capacity at some point during this period. All facilities were open by August 2020, though 14% were still operating at reduced capacity in September 2020. During periods of re-opening or reduced capacity, 93% of facilities reported prioritizing diagnostic breast imaging over breast cancer screening. For diagnostic imaging, facilities prioritized based on rescheduling canceled appointments (89%), specific indication for diagnostic imaging (89%), patient demand (84%), individual characteristics and risk factors (77%), and time since last imaging examination (72%). For screening mammography, facilities prioritized based on rescheduled cancelations (96%), patient demand (83%), individual characteristics and risk factors (73%), and time since last mammogram (71%). For biopsy services, more than 90% of facilities reported prioritization based on rescheduling of canceled exams, patient demand, patient characteristics and risk factors and level of suspicion on imaging. The observed patterns from this large and geographically diverse sample of facilities in the United States indicate that multiple factors were commonly used to prioritize breast imaging services during periods of reduced capacity.
COVID-19 大流行扰乱了美国的乳腺癌筛查和诊断成像。我们试图评估医疗设施在容量减少或关闭后重新开放期间如何优先考虑乳房成像服务。2020 年秋季，我们调查了美国乳腺癌监测联盟内的 77 家乳房成像设施。该调查确定了大流行对 2020 年 3 月至 9 月期间临床实践的影响。几乎所有设施（97%）都报告在此期间的某个时候关闭或减少运营能力。所有设施都在 2020 年 8 月前开放，尽管 2020 年 9 月仍有 14%的设施以减少的能力运营。在重新开放或减少能力的期间，93%的设施报告优先考虑诊断性乳房成像而不是乳腺癌筛查。对于诊断性成像，设施根据取消预约的重新安排（89%）、特定的诊断成像指征（89%）、患者需求（84%）、个体特征和危险因素（77%）以及上次成像检查以来的时间（72%）来优先考虑。对于筛查性乳房 X 线摄影，设施根据重新安排的取消预约（96%）、患者需求（83%）、个体特征和危险因素（73%）以及上次乳房 X 光检查以来的时间（71%）来优先考虑。对于活检服务，超过 90%的设施报告根据取消检查的重新安排、患者需求、患者特征和危险因素以及影像学上的怀疑程度来优先考虑。从美国这个大型且地理位置多样化的设施样本中观察到的模式表明，在容量减少期间，通常会使用多种因素来优先考虑乳房成像服务。
