Abstract
Objective: Here we analyze trends in breast cancer imaging over the past decade to evaluate the impact of changes in access to care and the COVID-19 pandemic on breast imaging utilization. Methods: We queried our radiology record system to identify numbers of specific breast imaging studies from 01/01/2010 to 03/31/21. We retrospectively assessed yearly numbers of exams since 2010 and weekly numbers during the COVID-19 pandemic in the greater New York City region. We performed Wilcoxon signed ranks tests to compare three-month periods during the pandemic to the same time period the prior year. Results: Ten-year trends in breast imaging showed an increase in screening mammography in the early part of the decade, which declined later in the decade. These changes corresponded to implementation of the Affordable Care Act in 2010 and the American Cancer Society Screening guidelines change in 2015. Breast MRI increased from 2017-2019, likely a delayed effect of research demonstrating a mortality benefit to high-risk women. Both screening mammography and breast MRI sharply declined during the height of the COVID-19 pandemic. Breast MRI has since rebounded, while screening mammography remains significantly reduced compared to 2019 exam numbers. Conclusion: Breast imaging exam numbers are affected by external events. Most recently, the COVID-19 pandemic significantly decreased screening mammograms and these have not rebounded to pre-pandemic levels. Given the proven benefit of screening mammography, this could have serious long-term effects for patients and should be carefully followed to ensure that all women get needed breast imaging and care.
Highlights
There has been controversy regarding the use of screening mammography, most notably based on results of the Canadian National Breast Screening Study, a large randomized controlled trial of screening mammography which reported no benefit to women from 40-49 [1], and later reported a similar lack of benefit in women 50-59 years of age [2]
These changes corresponded to implementation of the Affordable Care Act in 2010 and the American Cancer Society Screening guidelines change in 2015
Breast imaging exam numbers are affected by external events
Summary
There has been controversy regarding the use of screening mammography, most notably based on results of the Canadian National Breast Screening Study, a large randomized controlled trial of screening mammography which reported no benefit to women from 40-49 [1], and later reported a similar lack of benefit in women 50-59 years of age [2]. There has been controversy regarding the initial age at which to begin breast cancer screening and screening frequency since the inception of screening mammography [3,810]. Before 1980, yearly mammography was recommended for women after 50 years of age. From 1997-2009, a screening mammogram was recommended yearly after 40 years of age [11]. In 2015, the American Cancer Society (ACS) updated their guidelines for breast cancer in women with average risk, recommending that a woman discuss with her primary care physician (PCP) the need for screening mammography between the ages of 40-44, initiation of annual screening mammography at 45 years of age, transition to biannual screening at 54 years of age [12]. Little data is available regarding the effect this change had on utilization of screening mammography
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