Abstract
Purpose
The purpose of this study was to determine the impact of COVID-19 on county safety-net breast imaging services and describe the steps taken to actively manage and mitigate delays.
Methods
This was an IRB exempt retrospective review of our county safety-net breast imaging practice analyzed for 4 distinct time periods: (1) “Shut-down period”: March 17, 2020 to May 17, 2020; (2) “Phased re-opening”: May 18, 2020 to June 30, 2020; (3) “Ramp-up”: July 1, 2020 to September 30, 2020; and (4) “Current state”: October 1, 2020 to September 30, 2021. These time periods were compared to identical time periods 1 year prior. For “Current state,” given that the 1-year prior comparison encompassed the first 3 periods of the pandemic, the identical time period 2 years prior was also compared.
Results
Our safety-net practice sustained significant volume losses during the first 3 time periods with a 99% reduction in screening mammography in the shut-down period. Cancers diagnosed decreased by 17% in 2020 (n = 229) compared to 2019 (n = 276). By implementing multiple initiatives that targeted improved access to care, including building community-hospital partnerships and engagement through outreach events and a community education roadshow, we were able to recover and significantly exceed our pandemic screening volumes by 48.1% (27,279 vs 18,419) from October 1, 2020 to September 30, 2021 compared to the identical time period 1 year prior, and exceed our pre-pandemic screening volume by 17.4% (27,279 vs 23,234) compared to the identical time period 2 years prior.
Conclusion
Through specific community outreach programs and optimized navigation, our safety-net breast imaging practice was able to mitigate the impact of COVID-19 on our patient population by increasing patient engagement and breast imaging services.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
American Association for Cancer Research (2022) AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care. https://www.AACR.org/COVIDReport. Accessed 11 May 2022.
Guven DC, Sahin TK, Yildirim HC et al (2021) Newly diagnosed cancer and the COVID-19 pandemic: tumour stage migration and higher early mortality. BMJ Support Palliat Care. https://doi.org/10.1136/bmjspcare-2021-003301
Sim S, Marks E, Suttin J, Ben-Porath E, Evans-Pigford A (2020) Texans’ Views on the COVID-19 Pandemic. https://www.episcopalhealth.org/report-type/covid-19/ Accessed 11 May 2022.
Sharpless NE (2020) COVID-19 and cancer. Science 368(6497):1290. https://doi.org/10.1126/science.abd3377
Boserup B, McKenney M, Elkbuli A (2020) Disproportionate impact of COVID-19 pandemic on racial and ethnic minorities. Am Surg 86(12):1615–1622. https://doi.org/10.1177/0003134820973356
Balzora S, Issaka RB, Anyane-Yeboa A, Gray DM, May FP (2020) Impact of COVID-19 on colorectal cancer disparities and the way forward. Gastrointest Endosc 92(4):946–950. https://doi.org/10.1016/j.gie.2020.06.042
Roehr B (2022) Covid-19: Pandemic has harmed cancer outcomes and widened inequalities, report finds. BMJ 376:o375. https://doi.org/10.1136/bmj.o375
Parkland Annual Health Report 2021. https://www.parklandhealth.org/Uploads/public/documents/PDFs/Reports-Discolures/BOOK%20Annual%20Report%202021%20WEB.pdf. Accessed 11 May 2022.
Susan G. Komen (2018) Dallas County Community Profile Report 2015. https://komen-dallas.org/wp-content/uploads/2018/01/Komen-Dallas-County-2015-Community-Profile-Report1_2_18.pdf. Accessed 3 Oct 2020.
Ruhl JL, Callaghan C, Schussler N (2022) Summary Stage 2018: Codes and Coding Instructions, National Cancer Institute. https://seer.cancer.gov/tools/ssm/. Accessed 11 May 2022.
Pedrosa I, Browning T, Kwon JK et al (2020) Response to COVID-19: minimizing risks, addressing challenges and maintaining operations in a complex academic radiology department. J Comput Assist Tomogr 44(4):479–484. https://doi.org/10.1097/RCT.0000000000001040
Nyante SJ, Benefield TS, Kuzmiak CM, Earnhardt K, Pritchard M, Henderson LM (2021) Population-level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures. Cancer. https://doi.org/10.1002/cncr.33460
Chen RC, Haynes K, Du S, Barron J, Katz AJ (2021) Association of cancer screening deficit in the United States with the COVID-19 pandemic. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2021.0884
Bakouny Z, Paciotti M, Schmidt AL, Lipsitz SR, Choueiri TK, Trinh QD (2021) Cancer screening tests and cancer diagnoses during the COVID-19 pandemic. JAMA Oncol 7(3):458–460. https://doi.org/10.1001/jamaoncol.2020.7600
Velazquez AI, Hayward JH, Gregory B, Dixit N (2021) Trends in breast cancer screening in a safety-net hospital during the COVID-19 pandemic. JAMA Netw Open 8:e2119929. https://doi.org/10.1001/jamanetworkopen.2021.19929
McFarling UL (2021) The COVID cancer effect. Nature. https://doi.org/10.1038/d41586-021-03404-7
Grimm LJ, Lee C, Rosenberg RD et al (2022) Impact of the COVID-19 pandemic on breast imaging: an analysis of the national mammography database. J Am Coll Radiol. https://doi.org/10.1016/j.jacr.2022.04.008
Sokas C, Kelly M, Sheu C, Song J, Welch HG, Bergmark R, Minami C, Trinh QD (2021) Cancer in the shadow of COVID: early-stage breast and prostate cancer patient perspectives on surgical delays due to COVID-19. Ann Surg Oncol 28(13):8688–8696. https://doi.org/10.1245/s10434-021-10319-0
Richman IB, Hoag JR, Xu X, Forman HP, Hooley R, Busch SH, Gross CP (2019) Adoption of digital breast tomosynthesis in clinical practice. JAMA Intern Med 179(9):1292–1295. https://doi.org/10.1001/jamainternmed.2019.1058
Funding
BBO is fully supported by the Eugene P. Frenkel Scholarship in Clinical Medicine granted to BED by the UT Southwestern Simmons Comprehensive Cancer Center.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JHP, SJS, BBO, and BED. The first draft of the manuscript was written by JHP and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.
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The Human Research Protection Program at our institution reviewed our project and determined that this project met Institutional Review Board exemption given that the data analyzed were on a program level and not on an individual patient level.
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Porembka, J.H., Seiler, S.J., Ozcan, B.B. et al. Surviving the COVID-19 pandemic: navigating the recovery of breast imaging services in a safety-net hospital. Breast Cancer Res Treat 201, 127–138 (2023). https://doi.org/10.1007/s10549-023-07001-2
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DOI: https://doi.org/10.1007/s10549-023-07001-2