What We Know So Far About the Impact of the COVID-19 Pandemic on the Diagnosis, Treatment, and Prevention of Breast Cancer: Part I

By: Yvette C Terrie, BS Pharm, RPh, Consultant Pharmacist

This will be a 2-part series on the impact of the pandemic on diagnosis, treatment and screening of breast cancer, latest breakthroughs in therapies, and finally helping patients in their journey to combat breast cancer.

Every October is designated as Breast Cancer Awareness Month which is a valuable awareness incentive for a worthy cause, but we should be mindful about breast cancer and other cancers all year. In the United States, breast cancer accounts for 15% of total cancer deaths and is the second leading cause of cancer death in women, following lung cancer.¹ There are also over 3.5 million breast cancer survivors in the U.S.¹ Due to early detection and expanded breast cancer awareness and treatment, in 2017, there were an estimated 375,900 fewer breast cancer deaths.¹ Every day many women throughout the United States are diagnosed with breast cancer and therefore it is imperative that healthcare professionals including pharmacists seize every possible opportunity to educate patients about breast cancer awareness  including incidence, risk factors, signs, treatments and preventative and screening measures such as mammography and routine breast exams. According to the Breastcancer.org in 2020:²  

More facts about breast cancer can be found at https://www.breastcancer.org/symptoms/understand_bc/statistics

Impact of the Pandemic on Breast Cancer Diagnosis, Care and Prevention Thus Far

The pandemic has caused delays, changes and cancellations in screenings and treatments for breast cancer as well as diagnosis of breast cancer. 

According to a recent online survey conducted by breastcancer.org involving responses from 600 participants with 83% from the US and 42% actively receiving therapy for breast cancer, an estimated 70% of patients experienced treatment postponements in the period prior to June 7, 2020. The survey results also indicated the following: ³

• Delays for some patients were noted as: routine clinical visits (32%), surveillance imaging (14%), routine mammograms (11%), reconstruction (10%), hormonal therapy (5%), mastectomy (5%), radiation therapy (5%) and chemotherapy (4%).³
• Nearly 30% of these delays were reported as self-chosen, and about 80% of patients reported that anxiety about the pandemic impacted their cancer care. More than 50% of patients used telemedicine.³

Additionally, according to research published in August 2020 edition of JAMA Network indicated that far fewer cases of breast cancer and the five other common cancers (colorectal, lung, pancreatic and gastric cancers) are being diagnosed during the ongoing pandemic. The study revealed that the average weekly number of new diagnoses for 6 common cancers dropped by 46%, with breast cancer diagnoses declining the most (52%), in March and April compared to the two months prior.⁴ The authors concluded that the delay in diagnosis during the pandemic will probably result in more advanced stages of cancer and possibly poorer clinical outcomes. Kaufman et al noted that their study suggests a potential increase of 33, 890 excessive cancer deaths in the United States and that their findings are consistent with other research.^4-6 They also indicated that there is a need for urgent planning to address the consequences of delayed diagnosis. ⁴ Recommendations for this plan may entail the use of strong digital technology to reinforce clinical telehealth offerings and other patient-clinician interactions, including self-service scheduling across specialties and well-designed collection processes.⁴

Another study in the Journal of Clinical Oncology examined data from 20 institutions and found that in the first four months of 2020 compared to the same time last year, breast cancer screenings were down by 89%.⁷

Conclusion

Education is the most powerful tool that clinicians can use to encourage patients to take an active role in their health. As a result, patients can make informed choices about their health based on reliable clinical information. The pandemic has to some degree affected every facet of our daily lives including delivery of healthcare and other diseases were not stopped. As time goes on, we are all learning about the best ways to go about life and resume some aspects of life, while also protecting ourselves and others from the COVID-19 virus. Unfortunately, the ongoing pandemic has resulted in many cancellations and delays in mammogram screenings and routine checkups for several individuals. The good news is that many medical services have resumed in many areas across the country.  It is important that healthcare professionals try to encourage patients to remain proactive about their overall health while also reminding them to be vigilant about protecting themselves and others from the COVID-19 virus via infection control guidelines and preventative measures.

As one of the most accessible healthcare providers, pharmacists can be a fundamental source of clinical information for patients. They can also be a source of hope and encouragement for those at risk for or living with breast cancer. While there is still concern about the COVID-19 virus especially among patients in high risk patient populations, life to some degree is slowly returning to some degree of normalcy. During counseling, we can remind patients that healthcare facilities across the country are using infection control measures, social distancing and protective measures to shield their patients and healthcare workers against the virus. Patients should be encouraged to not delay screenings or routine care for other conditions including prevention and treatment of breast cancer.     

Yvette C. Terrie, Consultant Pharmacist, Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com/).

References

1. 2020 Brest Cancer Statistics. National Breast Cancer Foundation, Inc. https://www.nationalbreastcancer.org/wp-content/uploads/2020-Breast-Cancer-Stats.pdf   Accessed October 4, 2020.
2. U.S. Breast Cancer Statistics. Breastcancer.org website. https://www.breastcancer.org/symptoms/understand_bc/statistics  Updated June 25, 2020. Accessed October 4, 2020.
3. How COVID-19 Changed Breast Cancer Care. Cleveland Clinic Consult QD website.  https://consultqd.clevelandclinic.org/how-covid-19-changed-breast-cancer-care/  Published September 15, 2020. Accessed October 5, 2020.
4. Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the Number of US Patients With Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Netw Open. 2020;3(8):e2017267. doi:10.1001/jamanetworkopen.2020.17267.
5. Lai  A, Pasea  L, Banerjee  A,  et al . Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency.  medRxiv. Preprint posted online June 1, 2020. doi:10.13140/RG.2.2.34254.82242.
6. IJzerman M, Emery J. Is a delayed cancer diagnosis a consequence of COVID-19? https://pursuit.unimelb.edu.au/articles/is-a-delayed-cancer-diagnosis-a-consequence-of-covid-19  Published April 30, 2020. Accessed May 1, 2020.
7. London JW, Fazio-Eynullayeva E, Palchuk MB, Sankey P, McNair C. Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters. JCO Clin Cancer Inform. 2020 Jul;4:657-665. doi: 10.1200/CCI.20.00068. PMID: 32716647; PMCID: PMC7444638.