The Pink Pandemic: Breast Cancer Screenings Down Sharply During COVID-19 Era
In the year 2020, the year nobody will soon forget, “coronavirus,” “coronavirus update” and “coronavirus symptoms” were three of the most searched topics on Google. The pandemic, still to this day, has dominated almost every conversation and news headline and has lived at the forefront of the world’s mind. Along the way, basic routine checkups and procedures dwindled in numbers, and the repercussions could be cause for alarm.
The Centers for Disease Control and Prevention (CDC) released a report in June 2021 stating that breast cancer screening sharply declined by 87 percent over the course of the pandemic. There is a 1 in 8 chance that a woman living in the United States will contract breast cancer in her lifetime. The chance of having breast cancer increases over the age of 40, and breast screenings and mammograms are recommended as part of an annual health examination to stay ahead of diagnoses and treatments. Putting off these exams could cause a chain reaction that patients and their families are not prepared for.
Stacy Smith-Foley, MD, a breast imaging specialist of The Breast Center at CARTI, urges patients to get back into the routine of breast exams.
“The thing that I know about breast cancer is that it’s out there just waiting to be diagnosed, and we have our best chance for survival and the best chance to succeed when we diagnose it at an early stage,” Dr. Smith-Foley says. “A study was done out of the [United Kingdom] that said the number of patients we were going to find to have cancer in the next few years is going to be higher, and many of those patients will have a more advanced disease that may require more aggressive treatments that are more invasive, instead of somebody having their breast cancer diagnosed at a very early stage that will just have a lumpectomy and radiation therapy. If [a patient’s] disease is diagnosed at a later stage, it’s already evolved in the lymph nodes, and they’ll have to have chemotherapy and maybe a mastectomy.”
In a similar position of waiting on patients to come back to the lab, Gwendolyn Bryant-Smith, MD, chief of breast imaging and the Breast Imaging Fellowship Director in the Department of Radiology at UAMS, understands why patients have stayed away during the pandemic.
“When we perform mammograms, we’re all over the patients,” Dr. Bryant-Smith says. “Social distancing is almost impossible because we have to be incredibly close to the patient to screen their breasts and check for early stages of cancer.
Statistics, graphs courtesy Arkansas Department of Health.
“We keep our labs and exam rooms sanitized, and we are taking every precaution necessary to keep our patients safe during this time. Coming to the hospital right now with numbers as high as they are sounds dangerous, but we are doing everything in our power to ensure patients can continue staying on top of their health.”
A key detail of the CDC report emphasizes that the greatest decline in screenings came from ethnic minority groups and lower socio-economic groups at the very start of the pandemic. The report suggests that when access to medical services decreased at the beginning of the pandemic, the groups most affected were those in lower-income households.
“This situation also highlights that we have some disparities in our population,” Smith-Foley says. “There was a study in the summer released around the same time as the CDC report where they looked at a screening population in Washington state, and they found that patients that were not Caucasian and that came from lower socio-economic groups were less likely to have participated in screenings during the pandemic. If we really look at it, this decline wasn’t just breast cancer screenings, but also colonoscopies and annual visits to doctors. Pediatricians were not seeing very many patients at all because parents were not taking their kids to the doctor to get their vaccinations. Everybody was putting things off that they felt were not urgent, or things that didn’t have to immediately be attended to due to the circumstances.”
Coming out of the last few months with access to vaccinations, people have discovered during self-examinations that an effect of the COVID-19 vaccines in some people is swelling of the lymph nodes. Many found this alarming, as they did not know what the swelling meant or how it affected their breast health.
“The lymph nodes can swell for a temporary period of time after receiving a COVID vaccination, but it is not dangerous nor does it affect the screening,” Bryant-Smith says. “Some patients think they should continue putting off their exam because they have received a COVID vaccine and don’t want the swelling to interfere with their results. [Breast imaging specialists] know the difference between swollen lymph nodes and cancerous lumps, so please still come in to receive your screening. It is much better to come in now rather than put off a screening any later.”
Both doctors say that continuing to delay a breast cancer screening, especially for those over 40 and patients with a family history of breast cancer, puts the body more at risk for advanced stages of cancer.
Smith-Foley says, “It’s incredibly important to get back on track if you’ve fallen off schedule this past year and a half. There’s no time like the present to go ahead and schedule an appointment. Don’t wait like, ‘Oh, I used to get my mammograms in November.’ Just go ahead and schedule and get in. We have a lot of people that didn’t come in during the pandemic. We just want you to come in now so we can be safe. If there is something there, it’ll give us a better chance to find it now than in a few months. It’s safe to come in, especially to our Breast Center. We’re screened every day, we wear our masks, we’re socially distanced, we screen everyone coming into our facility, we’ve always had an extensive cleaning process, and we’ve always had private dressing rooms. Our center is designed for all of this.”
Bryant-Smith agrees, saying, “Don’t wait any longer — schedule your appointment now. The sooner you get in here and find out your results, the sooner we can move forward and continue keeping you safe and healthy. If some patients continue to push off their screening, the chances that we can catch cancer in an early stage and treat it quickly grows smaller. The pandemic has not been kind, but now is as good a time as any to make sure your breasts are in good health so that you have one less worry on your plate.”
Breast cancer is the most common cancer in women in the country and the second-leading cause of cancer-related deaths among women worldwide. On an average year in the United States, excluding 2020 and 2021, around 255,000 cases of breast cancer are diagnosed in women, and around 2,300 in men.
“Breast cancer doesn’t discriminate,” Smith-Foley says. “It doesn’t care what color your skin is; it doesn’t care how much money you make. The two biggest risk factors are being a female and growing older. So if you have breasts, then you’re at risk.”