Impact of COVID-19 on breast andprostate cancer screening and early detection in a largehealth care provider group
Authors: Mara M. Epstein, Devi Sundaresan, Meagan Fair, Lawrence Garber, Mary Charpentier, Jerry H. Gurwitz, Terry S. Field
Journal: Clinical Cancer Research (2020)

Purpose: Massachusetts has been heavily impacted by the COVID-19 pandemic with new cases rising from 6,621in March to 55,584 in April and 34,760 in May 2020  Most clinics and hospitals stopped performing electiveprocedures and reduced the volume of patients seeking in-person care starting in mid-March  This abstractquantifies the rates of mammography and PSA testing, both for screening and diagnostic purposes, as well asbreast and prostate biopsies performed during the first five months of 2020 as compared to the same months in2019 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 ofthe provider group between January 2019 and May 2020 were included in this analysis  We compared the monthlyrates per 1,000 people of mammography, total PSA, and breast and prostate biopsy for the period of January-May2019 and January-May 2020 overall and by age and race/ethnicity  Procedures were identified by CPT codes in thegroup'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 and82,695 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 ofmammograms declined significantly between January-May 2019 and the same months in 2020 from an average of13 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 inMay 2020  Digital tomosynthesis also declined from an average of 34 7 per 1,000 women in 2019 to 14 6, 1 4, and1 5 across March through May of 2020  The level of decline increased with age and was greatest among the oldestwomen, aged 75-85  Parallel declines occurred among all racial/ethnic groups  Breast biopsies declined steadilyfrom 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 inMay 2020  PSA testing was conducted in 2019 with an average of 34 4 men tested per 1,000 per month  Declines inPSA were slightly less than mammography with 17 6 tests completed per 1,000 men in March, 6 1 in April, and 11 3in May 2020  Prostate biopsies were infrequent in 2019 with an average of 0 15 per 1,000 men per month and didnot decline in 2020  Declines were slightly greater in younger men aged 30-54 and similar across racial/ethnicgroups  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 ofthe COVID-19 pandemic on cancer prevention and early detection, signaling possible downstream effects on thetiming and staging of future cancer diagnoses