Breast cancer detection delayed by COVID-19

David Lam

6/06/2024 4:41:57 PM

The rate of metastatic breast cancer doubled after breast screening programs shut down during the pandemic.

Stage 3 and 4 breast cancers increased from 4.6% to 8.5% during the pandemic, according to a new Australian study.

Experts say screening programs should be maintained during future pandemics, following a spike in the number of advanced breast cancers that has emerged in the wake of COVID-19-related lockdowns.
New research from Australian National University has revealed that significantly more women were being diagnosed with breast cancer in the later stage of the disease amid the pandemic years of 2019–22.
The study of patients at the Sydney Adventist Hospital, a major breast cancer centre for Northern Sydney and the Central Coast, found that more women had their breast cancer detected only after they had developed a breast lump, rather than through routine breast screening during COVID-19 (57%) compared to prior to the pandemic (53%).
It also showed that the number of stage 3 and 4 cancers, in which the cancer had already spread from the breast to other organs, had almost doubled from 4.6% pre-pandemic to 8.5% during and after the pandemic.
These more advanced cancers carry a poorer prognosis, as do oestrogen-receptor negative tumours with spread to lymph nodes. Unfortunately, the number of these node-positive breast cancers also doubled from 33% to 66% during the pandemic.
The study’s author and radiation oncologist, Professor John Boyages, attributes this surge in breast cancers to two factors.
He told newsGP that from 2019–22, many women were understandably apprehensive about attending GP and hospital appointments due to the fear of catching COVID-19 – a trend that persists in 2024.
‘People are still reluctant to get breast screening even now,’ he told newsGP.
‘Our service is seeing some women who haven’t had a mammogram since 2018.
‘They were due in 2020 but were unable to attend their appointment because of lockdowns and have only recently come back.’
Professor Boyages also highlights that due to COVID-19 lockdowns, the national BreastScreen Australia program was closed during 2020 and 2021 for a total of six months.
While he appreciates the difficulty in managing the competing priorities of preventive health and public safety, Professor Boyages stressed the importance of continuing cancer screening even during pandemics.
‘Our study clearly shows government and health authorities need to prioritise cancer screening in future pandemics,’ he said.
‘Why were women allowed to go a therapeutic massage but not screening?
‘Do we need to stop screening completely in the next pandemic? No.’
While the pandemic has posed challenges in breast cancer detection, there have been some positive outcomes during this period.
The study indicates that the health service became far more experienced in more rapid courses of radiotherapy for breast cancer, with some courses as brief as one week.
It also became more proficient in trialing chemotherapy prior to surgery to see how a cancer would respond, leading to significantly fewer women requiring mastectomies (24% post-pandemic compared to 33% pre-COVID).
Professor Boyages considers the insights gained as an opportunity for further research, looking at bigger data sets inclusive of other demographics such as in rural areas and communities where English is not someone’s first language. He also advocates for innovation in current cancer screening policies.
‘Key elements of our current breast screening model haven’t changed since 1993,’ he said.
‘Overseas, the US Preventive Services Task Force has recently recommended that screening mammograms should routinely occur from age 40. In Sweden and New Zealand, screening occurs in the 40s.
‘Here in Australia, we offer screening mammograms from age 50–74 but we should probably tweak this recommendation to occur at a younger age.’
Professor Boyages emphasises that, in light of COVID-19 disruptions and later breast cancer diagnoses, GPs play a pivotal role in creating better health outcomes for women.
‘The increased probability of having cancer spread to a patient’s lymph nodes and delayed diagnosis is likely to translate into poorer patient outcomes in the longer term,’ he said.
‘GPs are essential in encouraging and referring their patients to undergo breast screening.
‘They are our biggest motivator. A GP counselling a patient on breast health will always outperform compared to a sign on the roadside or bus stop.’
Dr Katrina Tiller, Sydney-based GP and Chair of RACGP Specific Interests Breast Medicine, also encourages a return to health habits including screening, which may have gone by the wayside during the pandemic.
‘The BreastScreen numbers have returned to pre-pandemic overall and the turnaround for results and recall to assessment clinic has also returned,’ she told newsGP.
‘BreastScreen Australia is very committed to actively following up women in their target group of 50–74, although only 50% of the target group attend.’
For this reason, Dr Tiller previously told newsGP that screening efforts should focus more on encouraging members of the existing target group to attend, rather than expanding it to incorporate more people.
‘Considering 75% of cancers are occurring in women over 50, and 50% of them are not being screened, then that’s where our energies should be going,’ she said.

‘Our big picture is we really do need to target that 50% of 50–74-year-olds who are not having their breasts checked so that we can minimise their morbidity, size of their surgery, and the amount of chemotherapy they might have to have and decrease that early mortality associated with a later diagnosis.’
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