Doctors concerned after 1000s of missed mammograms due to COVID

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The coronavirus consumed much of daily life in March for the Houston region, including things that are necessary but not constant, such as cancer screenings.

An IQVIA Institute for Human Data Science report published in April shows that a reduction of cancer screenings in the three months leading up to June 5 may have resulted in 36,000 delayed breast cancer diagnoses in the U.S.

However, the impacts of coronavirus on mammograms depended on the severity of the spread of cases in that region, according to studies presented on July 22 at the American Association of Cancer Research Virtual Meeting: COVID-19 and Cancer.

Later detection could have an impact on the death rate, said Jessica Jones, assistant professor of oncology at McGovern Medical School at UTHealth and an attending physician at Memorial Hermann Cancer Center.

“Research has shown that with medication, MRIs and mammograms we can effectively reduce breast cancer risks by 50 percent and curative rate, if we catch it early, is at 98 percent,” Jones said. “Every woman can get a personalized risk assessment predicting her chance of breast cancer.”

Closing the gap

In the Houston region, hospital systems and breast cancer prevention nonprofits are trying to get screenings back on track.

Memorial Hermann recently rolled out its Breast Cancer Prevention Program at both the Texas Medical Center and UT Physicians Multispecialty Clinic-Bayshore.

Meanwhile, nonprofits like Project Mammogram and The Rose are raising funds through online campaigns to provide free mammograms for low income people.

The Breast Cancer Prevention Program specializes in treating women who have higher risks of breast cancer with medication and additional screening. The program has been in the works for one year due to women getting less and less breast cancer screenings, Jones said. Although it’s currently only at two locations, the program is available for patients of any Memorial Hermann hospital in the Houston area.

“We have missed 36,000 (cases) of breast cancer already so this breast cancer awareness month is more important than ever,” Jones said.

Returning to the office

Ashmitha Srinivasan, chair of the breast division with Synergy Radiology Associates, said in March they were asking mammogram seekers to stay home for two reasons: they needed to make sure that they had enough personal protective equipment for medical staff and they wanted to minimize the exposure of the coronavirus to the community.

Now they know by wearing masks, washing hands often and through physical distancing, communities can slow down the spread of the coronavirus, Srinivasan said.

They screen patients for any COVID-19 exposure when they call to set up their appointments and when they arrive to the office. Every patient is provided with surgical masks as well, even if they have a homemade mask. Technologists are well equipped with PPE and minimize their exposure to patients.

“So now, in September, we are recommending that the patients who we said please do not come in for a screening mammogram back in March, we can tell them please do come in. It’s time to address your screening needs,” Srinivasan said. “Right now it’s important for all those women who have been putting off their screening mammogram back in March to actually receive care.”

Erica Warner, an assistant professor of medicine at Harvard Medical School who presented a Massachusetts General Hospital study said many doctors are concerned about the delays caused by the coronavirus pandemic.

“Our survey shows that the COVID-19 pandemic has disrupted breast cancer screening, including surveillance among women who have been diagnosed with breast cancer,” Warner said. “Our next steps will be to see if the affect of the pandemic on breast screening differed by demographic, geographic, or other respondent characteristics.”

COVID and cancer

Srinivasan said she and their surgeons and oncologists are still unsure how to weigh whether an individual may be more at risk of getting cancer after contracting COVID-19, Srinivasan said.

“As you can see, there are studies that are being done that are predicting how will this affect our community,” Srinivasan said. “And we want to minimize the damage, so to speak, by encouraging that all these women that have put off their imaging screenings, especially for cancer screening, to actually come in as soon as possible now so that way we can minimize the consequences of the delay in care and in delay in screening processes.”

Disparities in healthcare also fall into disparities in breast health care as well, Srinivasan said.

“Black women are affected more so by breast cancer because of the high mortality rate. And so we really want to encourage all women to come in for a screening, but especially high-risk women and especially the Black community to be aware of the consequences of delay in screening.”

Navigating mental health

Mental health already takes a toll when an individual is diagnosed with and treated for cancer. With the coronavirus pandemic, the economic downturn, and other extra factors adding on to the patient’s daily stress levels, they are greatly affected. While many of their patients, especially cancer survivors, are strong they also having this pandemic added to the burden Srinivasan said.

When hospitals had the no-visitor policy, they weren’t allowed to have the support system they would normally have for biopsies. Due to the anxiety brought on by treatments and screenings, Srinivasan said they normally would hug their patients and hold their hands before the pandemic to comfort them, but now she has to inform her staff, her radiologist and remind herself that they have to convey their empathy through PPE while physically distancing.

“Breast cancer, breast screening services in itself, is a very highly anxiety-provoking examination for the women,” Srinivasan said. “Especially cancer survivors who have had cancers in the past, when they come in for their routine surveillance, the appointment itself is a very anxious, worrisome procedure and when they actually had to weigh the risks between getting treatment and getting surveillance screening and to actually have the burden of worrying about the risk of COVID exposure, I mean, you’re just adding everything on top of it.”

However difficult the coronavirus pandemic has made the already stressful process of mammograms and cancer, Srinivasan says things are overall looking up. Patients have adapted to the new normal, but giving “virtual hugs” or air hugs, she said.

“Things were very difficult back in spring but now I think slowly we are starting to see that people are being more optimistic and things are definitely on the uphill now,” Srinivasan said.

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