Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic

Abstract

Background The COVID-19 pandemic reduced mammography utilization, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen-detected versus symptomatic) and women s characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations following mammography and/or ultrasound with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020. Monthly and cumulative biopsies recommended and performed, and subsequent cancers diagnosed in the pandemic period (March-September 2020) versus the pre-pandemic period were compared using Wald chi-squared tests. Analyses were stratified by mode of detection and race/ethnicity. Results From January 2019 to September 2020, 17,728 biopsies were recommended and performed with 6,009 subsequent cancers diagnosed. From March to September 2020, there were substantially fewer breast biopsy recommendations with cancer diagnoses compared to 2019 (1,650 in 2020 versus 2,171 in 2019, or 24% fewer in 2020; p<0.001), predominantly due to fewer screen-detected cancers (722 in 2020 versus 1,169 in 2019, or 38% fewer; p<0.001) versus symptomatic cancers (895 in 2020 versus 965 in 2019, or 7% fewer; p=0.27). Declines in cancer diagnoses were largest in Asian women [67 in 2020 versus 142 in 2019, or 53% fewer; p=0.06)] and Hispanic women [82 in 2020 versus 145 in 2019, or 43% fewer; p=0.13), followed by Black women [210 in 2020 versus 287 in 2019, or 27% fewer; p=0.21], and smallest in non-Hispanic White women [1,128 in 2020 versus 1,357 in 2019, or 17% fewer; p=0.09)]. Conclusion There were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared to the same period in 2019, with Asian and Hispanic women experiencing the largest declines followed by Black women. See also the editorial by Heller.