Breast Cancer Screening Program Research Articles

The feasibility of implementing risk stratification into a national breast cancer screening programme: a focus group study investigating the perspectives of healthcare personnel responsible for delivery

BackgroundProviding women with personalized estimates of their risk of developing breast cancer, as part of routine breast cancer screening programmes, allows women at higher risk to be offered more frequent screening or drugs to reduce risk. For this to be feasible, the concept and practicalities have to be acceptable to the healthcare professionals who would put it in to practice. The present research investigated the acceptability to healthcare professionals who were responsible for the implementation of this new approach to screening in the ongoing BC-Predict study.MethodsFour focus groups were conducted with 29 healthcare professionals from a variety of professional backgrounds working within three breast screening services in north-west England. An inductive-manifest thematic analysis was conducted.ResultsOverall, healthcare professionals viewed the implementation of personalised breast cancer risk estimation as a positive step, but discussion focused on concerns. Three major themes are presented. (1) Service constraints highlights the limited capacity within current breast services and concerns about the impact of additional workload. (2) Risk communication concerns the optimal way to convey risk to women within resource constraints. (3) Accentuating inequity discusses how risk stratification could decrease screening uptake for underserved groups.ConclusionsStaff who implemented risk stratification considered it a positive addition to routine screening. They considered it essential to consider improving capacity and demands on healthcare professional time. They highlighted the need for skilled communication of risks and new pathways of care to ensure that stratification could be implemented in financially and time constrained settings without impacting negatively on women.

Presenting Symptoms and Stage at Diagnosis Among Women Diagnosed With Breast Cancer Through a Combined Breast Cancer and Cervical Cancer Screening Program in Rwanda

PURPOSE There is interest in leveraging cervical cancer (CC) screening to facilitate early breast cancer (BC) detection in low- and middle-income countries (LMIC). We sought to determine whether adding clinical breast exams (CBE) to CC screening led to early BC diagnoses among asymptomatic women in Rwanda's Women's Cancer Early Detection Program (WCEDP). The WCEDP provided CBE to women aged 30-49 who were receiving CC screening, as well as any individual with breast symptoms. METHODS The WCEDP was launched in three Rwandan districts (total population 1.3 million) in July 2018, August 2018 and May 2019 respectively. This analysis included patients presenting to health centers (HCs) through December 31, 2019. Follow-up data were collected through April 2021 using clinicians' weekly reports, patient navigator referral data, and the cancer hospital's electronic medical record. We determined patients' initial symptoms from HC records, patient interviews, and phone surveys. RESULTS Nine thousand seven hundred sixty-three women received CC screening and CBE together; 7,616 additional women received CBE alone. Five hundred eighty-five women were referred from HCs to a district hospital (DH) for abnormal CBE; 200 were referred from the DH to the referral hospital. Twenty-nine women were diagnosed with BC; of these 19 (66%) were 50 or older and 23 (79%) had stage III/IV disease. Median interval from HC visit to referral hospital visit was 19 days (IQR 11.0-26.0). Among the 23 women with BC for whom we could identify their reason for initial HC presentation, all had sought care for breast symptoms. The remaining six had advanced-stage disease and symptomatic tumors at diagnosis. CONCLUSION During the initial rollout of this combined BC and CC screening program, no BC was diagnosed among asymptomatic women and 2/3 women diagnosed with BC were older than the target CC screening age. Adding CBE for all women receiving CC screening in LMIC may be low-yield. Given the high proportion of late-stage diagnoses, community awareness of early BC symptoms, high-quality CBE and timely referrals are important areas of focus.

Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

Should tomosynthesis replace mammography for breast cancer screening?

A decade has passed since the first prospective trials showed that the mammography technology, digital breast tomosynthesis, increased the rate of cancer detection compared with digital mammography. 1 Ciatto S Houssami N Bernardi D et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013; 14: 583-589 Summary Full Text Full Text PDF PubMed Scopus (608) Google Scholar , 2 Skaane P Bandos AI Gullien R et al. Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration. Eur Radiol. 2013; 23: 2061-2071 Crossref PubMed Scopus (170) Google Scholar A large body of evidence, comprising prospective non-randomised studies and retrospective studies, 3 Marinovich ML Hunter KE Macaskill P Houssami N Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall. J Natl Cancer Inst. 2018; 110: 942-949 Crossref PubMed Scopus (108) Google Scholar has since accumulated; however, evidence from randomised controlled trials is scarce. In The Lancet Oncology, Walter Heindel and colleagues report the results of the TOmosynthesis plus SYnthesised MAmmography Study (TOSYMA), 4 Heindel W Weigel W Gerß J et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022; (published online April 12.)https://doi.org/10.1016/S1470-2045(22)00194-2 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar a multicentre trial embedded in the German population-wide mammography screening programme. TOSYMA is the largest of three randomised controlled trials providing evidence on breast tomosynthesis versus mammography screening. 4 Heindel W Weigel W Gerß J et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022; (published online April 12.)https://doi.org/10.1016/S1470-2045(22)00194-2 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar , 5 Hofvind S Holen AS Aase HS et al. Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial. Lancet Oncol. 2019; 20: 795-805 Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar , 6 Pattacini P Nitrosi A Giorgi RP et al. A randomized trial comparing breast cancer incidence and interval cancers after tomosynthesis plus mammography versus mammography alone. Radiology. 2022; (published online Feb 1.)https://doi.org/10.1148/radiol.211132 Crossref PubMed Scopus (3) Google Scholar Heindel and colleagues persevered with TOSYMA despite the COVID-19 pandemic stalling recruitment, resulting in a marginally lower sample size than planned in their adaptive design. 4 Heindel W Weigel W Gerß J et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022; (published online April 12.)https://doi.org/10.1016/S1470-2045(22)00194-2 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trialThe results from this study indicate that the detection rate for invasive breast cancer was significantly higher with digital breast tomosynthesis plus s2D mammography than digital mammography alone. Evaluation of interval cancer rates in the follow-up study will further help to investigate incremental long-term benefits of digital breast tomosynthesis screening. Full-Text PDF

146P Breast cancer screening in Libya: Results of the first pilot study

Breast cancer is the most common female cancer and the second cause of death among women worldwide. Screening attendance is associated with a mortality reduction of at least 30% and a 40% lower risk of advanced disease. In Libya, breast cancer is the most common cancer in women. It is also the most common cause of cancer deaths. Unfortunately, most of the patients present with advanced disease, probably because there is no national breast cancer screening program in Libya. Pilot studies are small-scale, preliminary studies that aim to investigate whether crucial components of the main study – such as screening programs– will be feasible.

An Artificial Intelligence-based Mammography Screening Protocol for Breast Cancer: Outcome and Radiologist Workload.

Background Developments in artificial intelligence (AI) systems to assist radiologists in reading mammograms could improve breast cancer screening efficiency. Purpose To investigate whether an AI system could detect normal, moderate-risk, and suspicious mammograms in a screening sample to safely reduce radiologist workload and evaluate across Breast Imaging Reporting and Data System (BI-RADS) densities. Materials and Methods This retrospective simulation study analyzed mammographic examination data consecutively collected from January 2014 to December 2015 in the Danish Capital Region breast cancer screening program. All mammograms were scored from 0 to 10, representing the risk of malignancy, using an AI tool. During simulation, normal mammograms (score < 5) would be excluded from radiologist reading and suspicious mammograms (score > recall threshold [RT]) would be recalled. Two radiologists read the remaining mammograms. The RT was fitted using another independent cohort (same institution) by matching to the radiologist sensitivity. This protocol was further applied to each BI-RADS density. Screening outcomes were measured using the sensitivity, specificity, workload, and false-positive rate. The AI-based screening was tested for noninferiority sensitivity compared with radiologist screening using the Farrington-Manning test. Specificities were compared using the McNemar test. Results The study sample comprised 114 421 screenings for breast cancer in 114 421 women, resulting in 791 screen-detected, 327 interval, and 1473 long-term cancers and 2107 false-positive screenings. The mean age of the women was 59 years ± 6 (SD). The AI-based screening sensitivity was 69.7% (779 of 1118; 95% CI: 66.9, 72.4) and was noninferior (P = .02) to the radiologist screening sensitivity of 70.8% (791 of 1118; 95% CI: 68.0, 73.5). The AI-based screening specificity was 98.6% (111 725 of 113 303; 95% CI: 98.5, 98.7), which was higher (P < .001) than the radiologist specificity of 98.1% (111 196 of 113 303; 95% CI: 98.1, 98.2). The radiologist workload was reduced by 62.6% (71 585 of 114 421), and 25.1% (529 of 2107) of false-positive screenings were avoided. Screening results were consistent across BI-RADS densities, although not significantly so for sensitivity. Conclusion Artificial intelligence (AI)-based screening could detect normal, moderate-risk, and suspicious mammograms in a breast cancer screening program, which may reduce the radiologist workload. AI-based screening performed consistently across breast densities. © RSNA, 2022 Online supplemental material is available for this article.

‘I want to live for them’; Determinants of Uptake of Clinical Breast Examination: A Qualitative Inquiry

BackgroundClinical breast examination is still relevant in resource-constrained countries for the early detection of breast cancer. Uptake of breast cancer screening programmes in developing countries remains low. It is imperative to explore the factors that influence women’s decision to participate in screening services.ObjectiveTo examine the perceptions, motivations, and barriers to uptake of clinical breast examination.MethodsThis was a descriptive qualitative inquiry. Twelve women who participated in clinical breast examinations were purposively sampled for semi-structured interviews. Interviews were audio-taped, transcribed verbatim, and thematically analysed.ResultsFear of death, personal interest, excellent customer service, and public education motivated participation in the clinical breast examination. Perceived benefits included psychological relief, early detection, inspiring other women, and the acquisition of skills and knowledge. Anxiety about being diagnosed with breast cancer, financial constraints, poor service delivery, and peer pressure were the perceived barriers. Participants who felt anxious about breast cancer performed self-breast examinations more often than the standard practice. The knowledge of participants about breast cancer and breast cancer screening techniques was generally poor.ConclusionHealth interventions designed to promote health seeking behaviors need to be realigned to reflect the evidence on the factors influencing the uptake of these interventions.&#x0D; Rwanda J Med Health Sci 2022;5(1):85-98

Predicting Rural Women's Breast Cancer Screening Intention in China: A PLS-SEM Approach Based on the Theory of Planned Behavior.

BackgroundIt was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.MethodsA cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.ResultsThere were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).ConclusionThe TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.

Breast Cancer Screening in Low-Income Countries: A New Program for Downstaging Breast Cancer in Tanzania.

Background Most breast cancer diagnoses in Tanzania are in advanced stages. The Ocean Road Cancer Institute (ORCI) established a new breast cancer screening program in 2014 to reduce advanced-stage diagnoses. This study is aimed at describing the screening program's referral process and at identifying patient and health system factors that contribute to patients completing diagnostic testing referrals. Methods Six-hundred and forty patients were included in the study. Testing types, outcomes, and date of diagnostic results were abstracted from records at ORCI and Muhimbili National Hospital (MNH) to determine the proportion of testing completed and the duration between initial referrals and diagnostic tests. Prediction of completion of diagnostic testing was investigated in logistic regression. Results Of the patients who received referrals for further testing, fifty-two percent completed the recommended ultrasound (USS), mammography (MMG), and fine-needle aspiration cytology (FNAC). Only 33.0% of patients completed the recommended MMG referrals compared to 55.0% for ultrasound and 68.7% for FNAC. The average number of days between initial screening and results was 42 days for MMG, 20 days for USS, and 18 days for FNAC. Significant predictors for completing referrals for USS, FNAC, and MMG included age < 44 and >55 years, presenting with symptoms at the initial appointment, and education. The odds of completing an USS was 3.03 (95% CI, 1.65-5.64) for patients 25–34, 2.27 (95% CI, 1.17-4.48) for patients 35–44, and 4.41 (95% CI, 1.66-10.11) for patients older than 55 years compared to the reference group (age 19–24). The presence of symptoms at the initial appointment was a significant predictor of FNAC. The odds of completing an FNAC was 1.55 (95% CI, 1.02-3.72) for symptomatic compared to nonsymptomatic patients. Education was a significant predictor of MMG. The odds of receiving MMG was 4.29 (95% CI, 1.05-21.00) for patients with tertiary education or higher compared to primary education or lower. Possession of health insurance for treatment and living in Dar es Salaam were not significant predictors. Discussion. Future research should focus on patients' understanding of recommended referrals and factors that influence decision-making. Investigating the cost effectiveness of scaling up screening programs and setting up a patient navigation program that follow patients as they complete the recommended treatment plan will be crucial for Tanzania and other developing countries as they seek to launch and strengthen screening programs.

Efficacy of breast cancer screening program in Kingdom of Saudi Arabia.

B reast cancer (BC) is a globally challenging health concern and has become the most common type of cancer among women. The disease is associated with a significant health burden and mortality among women. In 2020, 2.3 million women were diagnosed with BC, and 685,000 deaths were reported globally.

BREAst screening Tailored for HEr (BREATHE)-A study protocol on personalised risk-based breast cancer screening programme.

Routine mammography screening is currently the standard tool for finding cancers at an early stage, when treatment is most successful. Current breast screening programmes are one-size-fits-all which all women above a certain age threshold are encouraged to participate. However, breast cancer risk varies by individual. The BREAst screening Tailored for HEr (BREATHE) study aims to assess acceptability of a comprehensive risk-based personalised breast screening in Singapore. Advancing beyond the current age-based screening paradigm, BREATHE integrates both genetic and non-genetic breast cancer risk prediction tools to personalise screening recommendations. BREATHE is a cohort study targeting to recruit ~3,500 women. The first recruitment visit will include questionnaires and a buccal cheek swab. After receiving a tailored breast cancer risk report, participants will attend an in-person risk review, followed by a final session assessing the acceptability of our risk stratification programme. Risk prediction is based on: a) Gail model (non-genetic), b) mammographic density and recall, c) BOADICEA predictions (breast cancer predisposition genes), and d) breast cancer polygenic risk score. For national implementation of personalised risk-based breast screening, exploration of the acceptability within the target populace is critical, in addition to validated predication tools. To our knowledge, this is the first study to implement a comprehensive risk-based mammography screening programme in Asia. The BREATHE study will provide essential data for policy implementation which will transform the health system to deliver a better health and healthcare outcomes.

How did COVID-19 Affect Breast and Colorectal Cancer Screening?

In the European Congress of Radiology (ECR) 2022 Overture, speakers discussed the disruptions to screening programmes for breast cancer and colorectal cancer that occurred during the COVID-19 pandemic. In the session, speakers shared the lessons they have learnt and ideas for improving screening to prevent future disruptions. COVID-19 has significantly impacted healthcare in a number of ways, from delaying screening procedures to the rapid roll-out of telemedicine. In this presentation, speakers from across Europe discussed how the pandemic impacted screening for breast and colorectal cancer, the adaptations that were made to screening programmes in response, and the subsequent consequences of these adaptations. Finally, the committee of the ECR 2022 Overture and the multidisciplinary panel had a highly engaging discussion.

X-ray dosimetry in breast cancer screening: 2D and 3D mammography

According to the World Health Organization (WHO), at the end of 2020, 7.8 million women alive were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. It is largely recognized and demonstrated that early detection represents the first strategy to follow in the fight against cancer. The effectiveness of mammography screening for early breast cancer detection has been proven in several surveys and studies over the last three decades. The estimation of the Mean Glandular Dose (MGD) is important to understand the radiation-associated risk from breast x-ray imaging exams. It continues to be the subject of numerous studies and debates, since its accuracy is directly related to risk estimation and for optimizing breast cancer screening programs.This manuscript reviews the main dosimetry formalisms used to estimate the MGD in mammography and to understand the continuing efforts to reduce the absorbed dose over the last forty years. The dosimetry protocols were formulated initially for mammography. Digital breast tomosynthesis (DBT) either in conjunction with synthesized digital mammogram (SDM) or with digital mammography (DM), is routinely used in many breast cancer screening programs and consequently the dosimetry protocols were extended for these techniques.

Breast Cancer Knowledge, Attitudes and Practices amongst Women in Qatar.

This cross-sectional study examines knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women residents in Qatar. Females, >18 years old, registered with the Primary Health Care Corporation were invited to complete an Arabic or English online survey using a modified version of the Breast Cancer Awareness Module. Of the 9008 participants, 69% report awareness of breast cancer warning signs, but the results did not substantiate these claims. There remains a disconnect between participants’ perceived awareness of their ability to detect breast cancer and their actual recognition of individual signs and symptoms. Nearly half (45.4%) report rarely or never checking their breasts for abnormalities (44.6%). Breast self-examination (BSE) and Breast Cancer Screening (BCS) uptake is low and many are unaware of the starting age for invitation to Qatar’s BCS program. While only 18% of women report receiving an invitation, 94% attended, indicating that the BCS invitation is a remarkably effective means of improving screening uptake. Policymakers should capitalize on early recognition, which is possible in the youthful population. Broadening awareness campaigns and interventions targeting a broader audience including males, community and religious leaders and healthcare professionals may prove more effective in Arab communities.

Mammography classification model trained from image labels only

The Cancer Registry of Norway organises a population-based breast cancer screening program, where 250 000 women participate each year. The interpretation of the screening mammograms is a manual process, but deep neural networks are showing potential in mammographic screening. Most methods focus on methods trained from pixel-level annotations, but these require expertise and are time-consuming to produce. Through the screenings, image level annotations are however readily available. In this work we present a few models trained from image level annotations from the Norwegian dataset: a holistic model, an attention model and an ensemble model. We compared their performance with that of pretrained models based on pixel-level annotations, trained on international datasets. From this we found that models trained on our local data with image-level annotation gave considerably better performance than the pretrained models from external data, although based on pixel-level annotations.

Twelve Years Implementation of Cervical and Breast Cancer Screening Program in Indonesia.

Objective:The study aimed to measure achievement of the national program of cervical and breast cancer screening in Indonesia after 12 years implementation and factors associated with the number of the screening. Methods:This was a cross-sectional study with descriptive and analytic analysis. Secondary data was collected from Directorate of Non Communicable Disease Control, Ministry of Health. Results:From 2007 to 2018, the program was implemented in all 34 provinces, at 51% primary health centers (PHC) with 3 providers each. Total women aged 30-50 years screened was 3,664,625 (9.8% of the target). The number rose gradually from 2007 to 2014, with significant increase from 2015 to 2018. Bali province had the highest coverage (31%) and Papua had the lowest (1%). We found a wide disparity of coverage among provinces. There was 3.4% of VIA-positive, 16.1% was treated with cryotherapy, 1.3 per 1,000 of suspected cervical cancer, 5,4% lump in the breast, and 0.7 per 1,000 suspected breast cancer. Factors associated with number of the screening were number of PHC providing screening, number of GP, total provider, number of NCD post, number of Village with NCD Post, and income of the province. Conclusion:The cervical and breast cancer screening program was running in all provinces in more than half of primary health centers in Indonesia. National coverage (9.8%) was far below the target and varied widely among provinces. Number of PHC with screening services, number of GP, number of total provider, number of NCD post, number of Village with NCD Post, and income of the province have association with cervical and breast cancer screening.

What do women and healthcare professionals expect of decision aids for breast cancer screening? A qualitative study in France

ObjectiveBreast cancer screening decision aids (DAs) are designed to help women decide whether or not to participate in mammography-based programmes. We aimed to explore women’s and healthcare professionals’ expectations of...

Flemish population-based cancer screening programs: impact of COVID-19 related shutdown on short-term key performance indicators

BackgroundMany breast, colorectal, and cervical cancer screening programs were disrupted due to the COVID-19 pandemic. This study aimed to estimate the short-term impact of the temporary shutdown (from March until May- June) of the cancer screening programs invitations in Flanders (Belgium) by looking at invitation coverage, percentage of people screened after invitation and the screening interval.MethodsYearly invitation coverage was calculated as the number of people who received an invitation, as a proportion of the people who should have received an invitation that year. Weekly response to the invitation was calculated as the number of people who were screened within 40 days of their date of invitation, as a percentage of the people who received an invitation that week (as a proxy for willingness to screen). Weekly screening interval was calculated as the mean number of months between the current screening and the previous screening of all the people who screened that week. The two last indicators were calculated for each week in 2019 and 2020, after which the difference between that week’s value in 2020 and 2019 with 95% confidence intervals. Results of these two indicators were also analysed after stratification for gender, age and participation history.ResultsInvitation coverage was not impacted in the colorectal and cervical cancer screening program. In the breast cancer screening program invitation coverage went down from 97.5% (2019) to 88.7% (2020), and the backlog of invitations was largely resolved in the first six months of 2021. The willingness to screen was minimally influenced by COVID-19. The breast cancer screening program had a temporary increase in screening interval in the first months following the restart after COVID-19 related shutdown, when it was on average 2.1 months longer than in 2019.ConclusionsWillingness to screen was minimally influenced by COVID-19, but there may be an influence on screening coverage because of lower invitation coverage, mainly for the for breast Cancer Screening Program. The increases in screening intervals for the three Cancer Screening Program seem reasonable and would probably not significantly increase the risk of delayed screening cancer diagnoses. When restarting a Cancer Screening Program after a COVID-19 related shutdown, monitoring is crucial.

Abstract P3-12-37: The impact of the COVID-19 outbreak on breast cancer stage in the Netherlands by screening status

Abstract Introduction: The COVID-19 outbreak led to the suspension of the Dutch breast cancer screening program, increased the reluctance of patients to visit the general practitioner (GP), and led to a lack of capacity at the GP. As a consequence, the incidence of breast cancer diagnoses decreased. Objective: This study aimed to investigate the impact of the COVID-19 outbreak on the incidence of different stages of breast cancer, by screening status. Methods: Women diagnosed between January 1st 2017 and February 28th 2021 with primary breast cancer without a history of breast cancer were selected from the Netherlands Cancer Registry. March 1st 2020 till February 28th 2021 was regarded as the COVID-19 period. Breast cancer incidence within this COVID-19 period was calculated by tumor stage and compared with the incidence in 2017/2019 (reference). Incidence was expressed per 100,000 women aged 18 year or older, living in the Netherlands at the start of the year. Thereafter, the COVID-19 period was divided into four subperiods, based on COVID-19 related events: March-April 2020, May-June 2020, July-August 2020, September 2020-February 2021. Incidence in each of those periods was calculated by tumor stage and compared with the incidence in 2017/2019. Analyses were further stratified by screening status. Incidence of screen-detected tumors was expressed per 100,000 women aged 50-74 living in the Netherlands at the start of the year. Results: A total of 15,916 women were diagnosed in 2017, 15,574 in 2018, 15,867 in 2019, 13,497 in 2020 and 2,532 up to February 2021. Compared to 2017/2019, the incidence of DCIS and stage I-III tumors was statistically significantly lower during the COVID-19 period (32%, 24%, 9% and 11% respectively) (Table 1), leading to 603, 1539, 520 and 160 missed diagnoses respectively. The incidence of stage IV tumors was 5% higher, however this was not significant. The incidence of DCIS remained significantly lower throughout the four subperiods, while the incidence of stage I-II tumors was comparable with 2017/2019 in September 2020-February 2021 and the incidence of stage III was comparable with 2017/2019 in both July-August 2020 and September 2020-February 2021. The incidence of DCIS and stage I-II non-screen-detected tumors was significantly lower during March-April 2020 and was comparable with 2017/2019 in the subperiods thereafter. The incidence of DCIS and stage I-IV screen-detected tumors was significantly lower during March 2020-February 2021, with the incidence of DCIS and stage I-III tumors being lower during each subperiod and the incidence of stage IV tumors being lower during May-June 2020. Conclusion: The COVID-19 outbreak led to a decrease in the incidence of DCIS and stage I-III tumor diagnoses, which still lags behind in February 2021. Until February 2021 no stage shift was seen. Incidence of breast cancer diagnoses per tumor stage and screening statusDCISStage IStage IIStage IIIStage IVReference126.590.876.820.411.0COVID-19 period218.069.269.518.111.5March - April reference14.515.112.73.61.8March - April 20202.28.18.48.41.4May - June reference14.115.413.83.71.9May - June 20201.57.510.52.91.9July - August reference14.315.413.13.31.9July - August 20202.310.711.63.42.2September - February reference113.644.937.39.85.4September 2020 - February 202112.042.939.09.26.0Non-screen-detectedDCISStage IStage IIStage IIIStage IVReference18.841.258.817.910.4COVID-19 period27.639.958.016.611.2March - April reference11.46.99.73.11.7March - April 20200.95.07.02.61.4May - June reference11.67.610.83.11.9May - June 20201.47.210.52.91.9July - August reference11.36.910.03.01.8July - August 20201.16.910.23.22.1September - February reference14.519.828.28.55.1September 2020 - February 20214.320.830.38.05.8Screen-detected3DCISStage IStage IIStage IIIStage IVReference145.3127.146.36.31.3COVID-19 period226.374.127.02.90.6March - April reference18.021.07.51.20.2March - April 20203.58.03.30.20.1May - June reference16.520.17.51.10.2May - June 20200.30.70.20.10.0July - August reference17.621.78.00.80.3July - August 20203.29.73.60.40.1September - February reference123.364.323.33.30.7September 2020 - February 202119.355.819.92.20.4Incidence is expressed per 100,000 women living in the Netherlads Bold: the incidence in that period of 2020/2021 is statistically significantly lower/higher compared to the incidence in the same period of 2017/2019 (averaged) 1. Reference period: 2017/2019 2. COVID-19 period: March 2020 -February 2021 3. Expressed per 100,000 women aged 50-74 years Citation Format: Anouk H Eijkelboom, Sabine Siesling, Linda de Munck, Carla H van Gils, Marc BI Lobbes, Vivianne CG Tjan-Heijnen, Luc JA Strobbe, Jelle Wesseling, Ruud M Pijnappel, Mireille JM Broeders, NABON-COVID-19 consortium, COVID and Cancer Care-NL consortium (ZONMW number10430022010014). The impact of the COVID-19 outbreak on breast cancer stage in the Netherlands by screening status [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-37.

Abstract P2-11-08: Impact of COVID-19 on patients undergoing neoadjuvant therapy: A pre/post pandemic analysis and assessment of quality of care delivered

Abstract Background: When the first wave of COVID-19 hit globally in early 2020, concerns were raised about access to surgical interventions for cancer patients. It was considered that neoadjuvant therapy (NAT) although conventionally given to locally advanced breast cancer may need to also be provided to earlier-stage disease. In addition, due to the temporary closure of breast cancer screening programs during the pandemic, concerns were raised about patients presenting with later-stage disease at initial diagnosis. This project aims to assess the impact of COVID-19 on the volume of neoadjuvant referrals at a large cancer centre, as well as any stage migration, impact on treatment timelines and impact on outcomes for breast cancer patients compared to the pre-pandemic population. Methods: The BC Cancer Vancouver centre has a neoadjuvant breast cancer program to ensure high quality of care is maintained. This program’s prospective database of breast cancer patients referred for and treated with NAT between the years 2012-2021 was queried to assess data on neoadjuvant referrals, clinical stage, receptor status, treatment timelines, and outcomes between January 1, 2019 - December 31, 2020. Data from the years 2019 and 2020 were compared to evaluate the impact of COVID-19 on NAT. Summary data available from earlier years were also utilized as reference. Results: The COVID-19 pandemic resulted in a 51% increase in the number of patients referred to the neoadjuvant program, with 102 patients referred for NAT in 2019, whereas 154 patients were referred in 2020. This proportional increase in referrals is higher than any other year since the database inception. Of note, during 2020 there were no COVID related closures for cancer surgeries in the province. The proportion of patients referred who received NAT remained similar between 2019 and 2020 (69.1% vs 70.8% in 2020). The trend in referrals by month varied between the two years. In 2019, the majority of patients were referred between April to July with the lowest proportion of referrals in October to December. In 2020, the opposite occurred with the lowest proportion of referrals transpiring between January - June, and the greatest proportion in October to December. The proportion of patients who presented with de-novo metastatic disease was consistent between the two years (7.8% in 2019 vs 9.7% in 2020). Despite the closure of all screening mammography programs between March-June of 2020, the clinical stage and receptor status are equivalent between 2019 and 2020. With regards to treatment timelines, there was a 3 day increase in the median time between referral date and medical oncology consultation in 2020 compared to 2019. No other treatment timeline delays were found between 2019 and 2020. With regards to outcomes, 34.9% of patients achieved pCR in 2019, but only 24.1% achieved pCR in 2020, despite similar stage and receptor subtypes. Conclusion: During the COVID-19 pandemic in 2020, a higher volume of patients were referred for NAT than had ever before been referred, despite the fact that there were no closures of operating rooms in our province for COVID-19. From a quality of care perspective there was a delay in referral to consultation for medical oncology, but no delay on referral to treatment, treatment to surgery, or surgery to radiation. However, and a significantly lower pCR rates was seen in 2020 compared to 2019. The 10% decrease in pCR rates may have resulted from increased complexity in breast cancer cases. This trend may continue, as the impact of COVID-19 on breast cancer outcomes will likely take many years to fully appreciate. Attention should be paid to encouraging women to return to regular breast screening programs to decrease the number of patients needing neoadjuvant therapy. Citation Format: Lauren Corke, Omar Hajjaj, Kaylie Willemsma, Stephen Chia, Christine Simmons. Impact of COVID-19 on patients undergoing neoadjuvant therapy: A pre/post pandemic analysis and assessment of quality of care delivered [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-08.