Breast
Olivia W. Galloway, MD
Surgery Resident
Lankenau Medical Center- Main Line Health
Wynnewood, Pennsylvania, United States
Olivia W. Galloway, MD
Surgery Resident
Lankenau Medical Center- Main Line Health
Wynnewood, Pennsylvania, United States
Olivia W. Galloway, MD
Surgery Resident
Lankenau Medical Center- Main Line Health
Wynnewood, Pennsylvania, United States
Georgia Montone, MS
Data Analyst
Center for Population Health Research, Lankenau Institute of Medical Research, United States
Stephanie Kjelstrom, MPH, CPH
Biostatistician
Man Line Health Center for Population Health Research, United States
Ned Z. Carp, MD, FACS
Chief of Surgery
Lankenau Medical Center- Main Line Health
Wynnewood, Pennsylvania, United States
The coronavirus-19 (COVID-19) pandemic disrupted healthcare delivery in breast cancer care through temporary suspension of screening programs and closure of elective procedures and operating rooms. There are conflicting results regarding changes in breast cancer stages during the COVID-19 pandemic. This study sought to utilize the National Cancer Database (NCDB) to investigate the changes and patterns in breast cancer staging during the pandemic.
Methods:
In this IRB-approved study, females diagnosed with breast cancer in 2019 (pre-COVID) and 2020 (during-COVID) were identified from the NCDB. Demographic variables including age, race/ethnicity, median income quartile, health insurance status, and geographic location were recorded. The percentage of patients in each pathologic tumor, node, metastasis stage and overall stage group was compared between the pre-COVID and during-COVID periods. Patients were further stratified by the demographic variables listed above and changes in staging pre- and during-COVID were analyzed in each group.
Results:
500,233 patients diagnosed with breast cancer in 2019 and 2020 were identified: 268,210 in 2019 and 232,023 in 2020. There was a significant difference in the overall stage group between years: a higher proportion of patients were diagnosed with Stage I and Stage IV breast cancer in 2020 compared to 2019 (69.7% vs 68.7% and 2.6% vs 2.3% respectively, p< 0.001). When stratifying by region, these differences were seen in the South Atlantic, East North Central, West North Central, West South Central, and Pacific regions (all p< 0.05). There were significant differences by income: patients in the middle two income quartiles had a significantly higher proportion of patients diagnosed with metastatic disease in 2020 (1.7% vs 1.4% and 1.5% vs 1.3% respectively, p < 0.001). Patients in the lowest income quartile had the largest decrease in Stage I, Stage II, and Stage IV (17.4%, 28.6%, and 17.2%) diagnoses in 2020. Patients with no insurance had the largest decreases in Stage 0, I and II diagnoses (33%, 20.4% and 33.5%) while those with private insurance had the largest decrease in Stage III and Stage IV diagnoses (27.9% and 9.1%) in 2020.
Conclusions:
The COVID-19 pandemic impacted breast cancer diagnosis and staging in the United States disproportionately with regards to insurance status, income, and geography. These differences may be due to changes in access to care during the pandemic. Further research is required to determine if the staging differences will result in changes in long-term survival.