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To begin with, the COVID-19 pandemic disrupted medical care significantly as millions of electoral processes were postponed or canceled. While the volume of many proceedings recovered by the end of July 2020, the disruption caused a massive backlog. In a recent article in Health Services Research, LDI Associate Fellow and Postdoctoral Fellow Alon Bergman and his co-authors examine the impact of the COVID-19 pandemic on a common procedure, mammograms, and answer the question: When can we expect that Solve a problem? queue up and return to regular operation?
Using damage data from Independence Blue Cross, a major regional health insurer, we estimate that 58% of expected routine screening mammograms and 38% of expected diagnostic mammograms were not performed between March 11 and July 28, 2020. We then forecast how long it would take to clear this queue of missing mammograms. In the best case scenario, we would assume that it would take at least 22 weeks to clear the queue. In the worst case scenario, however, demand will continue to exceed capacity and the order backlog will grow.
Our sample includes nearly 600,000 mammograms taken between January 1, 2018 and July 28, 2020. Most of the mammograms examined (88%) were routinely performed and used to detect early-stage breast cancer. The others were diagnostic mammograms (12%) taken after a palpable mass was detected or after an abnormal screening result.
We estimate the number of missing screening and diagnostic mammograms from March 11 to July 28, 2020 using a difference-in-difference method by matching the weekly number of mammograms taken in the same period (weeks 11 to 30) with those Compare the beginning of the year (weeks 1-10) in 2018, 2019 and 2020. As shown in Figure 1a, routine screening mammograms decreased by almost 99% of their expected weekly values in early April 2020 and recovered in May, Lagen but still 14% below the expected value by the end of July. We found a similar, if less severe, trend for diagnostic mammograms, down 74% by April, but bouncing back to previous years’ levels by the end of July (Figure 1b). Worryingly, these significant decreases were also seen in women with a previous diagnosis of breast cancer, with a 40% decrease in screening mammograms and a 30% decrease in diagnostic mammograms in weeks 11-30 of 2020.
Based on previous studies that found the incidence of truly positive screening mammograms to be between 51% and 82%, we estimate that the 39,200 missing screening mammograms result in 200 to 320 cases of delayed breast cancer diagnosis in the insurer’s population , of which 130 to 200 will be invasive cancer. We anticipate that in the absence of diagnostic screening cases, the true positive rate will be higher (possibly significant), as diagnostic mammograms are only scheduled after an abnormal finding.
To estimate how long it can take to get one for women who have missed a mammogram (either type), we apply our estimates to a basic research queuing formula. We consider different scenarios based on (a) how social distancing guidelines and new cleaning protocols might decrease capacity; and (b) how vendors could extend their operating hours to increase capacity. Even in the best-case scenario, where capacity is only marginally impacted by social distancing policies and providers increase their operating hours by 50%, it would take 22 weeks or 5 months to clear the queue. This calculation was based on the assumption that demand for mammograms would remain at week 30, which means that after July 28, there will be no further lockouts, on-site orders, or other events that could slow demand would occur. With a second wave of COVID, if most regions in the US are affected in the fall of 2020, it is likely that our “best case scenario” has already not been implemented.
Our data represents only one insurer and one type of cancer screening – a fraction of the patients affected by delays in non-urgent health care. Breast cancer isn’t the only form of cancer with reduced screening rates. Given the importance of early detection in the treatment of other cancers, the full effects of what appear to be changes in screening patterns over time during the pandemic may not be seen in years to come.
The article Disruptions in Prevention: Mammograms During the COVID-19 Pandemic was published online in Health Services Research on November 4, 2020.
Don’t hesitate to get mammograms, other breast cancer screening
Hummy Song et al. Disorders in Prevention: Mammograms During the COVID-19 Pandemic, Health Services Research (2020). DOI: 10.1111 / 1475-6773.13596 Provided by the University of Pennsylvania
Quote: The backlog in mammograms during the COVID-19 pandemic (2021, January 15) was retrieved from https://medicalxpress.com/news/2021-01-backlog-mammograms-covid-pandemic.html on January 15, 2021
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