Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Providence Saint John's Cancer Institute, Santa Monica, CA, USA.
Ann Surg Oncol. 2023 May;30(5):2883-2894. doi: 10.1245/s10434-023-13119-w. Epub 2023 Feb 7.
Measures taken to address the COVID-19 pandemic interrupted routine diagnosis and care for breast cancer. The aim of this study was to characterize the effects of the pandemic on breast cancer care in a statewide cohort.
Using data from a large health information exchange, we retrospectively analyzed the timing of breast cancer screening, and identified a cohort of newly diagnosed patients with any stage of breast cancer to further access the information available about their surgical treatments. We compared data for four subgroups: pre-lockdown (preLD) 25 March to 16 June 2019; lockdown (LD) 23 March to 3 May 2020; reopening (RO) 4 May to 14 June 2020; and post-lockdown (postLD) 22 March to 13 June 2021.
During LD and RO, screening mammograms in the cohort decreased by 96.3% and 36.2%, respectively. The overall breast cancer diagnosis and surgery volumes decreased up to 38.7%, and the median time to surgery was prolonged from 1.5 months to 2.4 for LD and 1.8 months for RO. Interestingly, higher mean DCIS diagnosis (5.0 per week vs. 3.1 per week, p < 0.05) and surgery volume (14.8 vs. 10.5, p < 0.05) were found for postLD compared with preLD, while median time to surgery was shorter (1.2 months vs. 1.5 months, p < 0.0001). However, the postLD average weekly screening and diagnostic mammogram did not fully recover to preLD levels (2055.3 vs. 2326.2, p < 0.05; 574.2 vs. 624.1, p < 0.05).
Breast cancer diagnosis and treatment patterns were interrupted during the lockdown and still altered 1 year after. Screening in primary care should be expanded to mitigate possible longer-term effects of these interruptions.
为应对 COVID-19 大流行而采取的措施中断了常规的乳腺癌诊断和治疗。本研究旨在通过全州范围内的队列研究来描述大流行对乳腺癌治疗的影响。
我们使用大型健康信息交换的数据，回顾性分析了乳腺癌筛查的时间，并确定了一组新诊断的任何阶段乳腺癌患者的队列，以进一步获取有关其手术治疗的信息。我们比较了四个亚组的数据：封锁前（preLD）期（2019 年 3 月 25 日至 6 月 16 日）；封锁期（LD）（2020 年 3 月 23 日至 5 月 3 日）；重新开放期（RO）（2020 年 5 月 4 日至 6 月 14 日）；和封锁后（postLD）期（2021 年 3 月 22 日至 6 月 13 日）。
在 LD 和 RO 期间，队列中的筛查乳房 X 光片分别减少了 96.3%和 36.2%。乳腺癌的整体诊断和手术量减少了 38.7%，手术时间中位数从 1.5 个月延长到 2.4 个月，LD 期为 1.8 个月。有趣的是，与 preLD 相比，postLD 时的平均 DCIS 诊断（每周 5.0 例 vs. 每周 3.1 例，p<0.05）和手术量（每周 14.8 例 vs. 每周 10.5 例，p<0.05）更高，而手术时间中位数更短（1.2 个月 vs. 1.5 个月，p<0.0001）。然而，postLD 的平均每周筛查和诊断乳房 X 光片并未完全恢复到 preLD 水平（2055.3 次 vs. 2326.2 次，p<0.05；574.2 次 vs. 624.1 次，p<0.05）。
在封锁期间，乳腺癌的诊断和治疗模式被中断，并且在 1 年后仍然受到影响。应扩大初级保健中的筛查范围，以减轻这些中断的可能长期影响。
