Abstract S11-03: Impact of COVID-19 on breast and prostate cancer screening and early detection in a large health care provider group
Authors: Epstein Mara M. , Sundaresan Devi , Fair Meagan , Garber Lawrence , Charpentier Mary , Gurwitz Jerry H. , Field Terry S. 
Published: December 2020

Abstract
Purpose: Massachusetts has been heavily impacted by the COVID-19 pandemic with new cases rising from 6,621 in March to 55,584 in April and 34,760 in May 2020. Most clinics and hospitals stopped performing elective procedures and reduced the volume of patients seeking in-person care starting in mid-March. This abstract quantifies the rates of mammography and PSA testing, both for screening and diagnostic purposes, as well as breast and prostate biopsies performed during the first five months of 2020 as compared to the same months in 2019 for a large health care provider group in central Massachusetts.
Methods: Men and women aged 30-85 without a history of breast or prostate cancer who were active patients of the provider group between January 2019 and May 2020 were included in this analysis. We compared the monthly rates per 1,000 people of mammography, total PSA, and breast and prostate biopsy for the period of January-May 2019 and January-May 2020 overall and by age and race/ethnicity. Procedures were identified by CPT codes in the group’s electronic health record.
Results: In total, 65,312 men and 80,629 women were included in the analysis of 2019 data and 66,396 men and 82,695 women in 2020. About 70% of the population was non-Hispanic white, 3% non-Hispanic Black, 4% Hispanic, 4% Asian, and 18% other/unknown. The median age was 53 for men and 52 for women. The monthly number of mammograms declined significantly between January-May 2019 and the same months in 2020 from an average of 13.6 mammograms per 1,000 women per month in 2019 to 6.1 in March, 0.25 in April and 1.1 per 1,000 women in May 2020. Digital tomosynthesis also declined from an average of 34.7 per 1,000 women in 2019 to 14.6, 1.4, and 1.5 across March through May of 2020. The level of decline increased with age and was greatest among the oldest women, aged 75-85. Parallel declines occurred among all racial/ethnic groups. Breast biopsies declined steadily from an average of 0.9 per 1,000 women per month in 2019 to 0.8 in March, 0.4 in April and 0.1 per 1,000 women in May 2020. PSA testing was conducted in 2019 with an average of 34.4 men tested per 1,000 per month. Declines in PSA were slightly less than mammography with 17.6 tests completed per 1,000 men in March, 6.1 in April, and 11.3 in May 2020. Prostate biopsies were infrequent in 2019 with an average of 0.15 per 1,000 men per month and did not decline in 2020. Declines were slightly greater in younger men aged 30-54 and similar across racial/ethnic groups. The greatest single-month change in test rates occurred between April 2019 and April 2020 in both women (screening mammogram rate declined 98%, tomosynthesis 96%) and men (PSA testing rate declined 83%), reflecting the peak of the COVID-19 surge in Massachusetts.
Conclusions: The observed decline in these common screening and diagnostic procedures reflects the impact of the COVID-19 pandemic on cancer prevention and early detection, signaling possible downstream effects on the timing and staging of future cancer diagnoses.
Citation Format: Mara M. Epstein, Devi Sundaresan, Meagan Fair, Lawrence Garber, Mary Charpentier, Jerry H. Gurwitz, Terry S. Field. Impact of COVID-19 on breast and prostate cancer screening and early detection in a large health care provider group [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S11-03.