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Showing content from https://pubmed.ncbi.nlm.nih.gov/35624175/ below:

Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population

. 2022 Jul;194(2):475-482. doi: 10.1007/s10549-022-06634-z. Epub 2022 May 27. Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population

Affiliations

¹ Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. caswell@stanford.edu.
² Center for Clinical Sciences Research, Stanford University School of Medicine, Room 1145C, Stanford, CA, 94305-5405, USA. caswell@stanford.edu.
³ Dan L Duncan Cancer, Baylor College of Medicine, Houston, TX, USA.
⁴ Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

PMID: 35624175
PMCID: PMC9140322
DOI: 10.1007/s10549-022-06634-z

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Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population

Jennifer L Caswell-Jin et al. Breast Cancer Res Treat. 2022 Jul.

. 2022 Jul;194(2):475-482. doi: 10.1007/s10549-022-06634-z. Epub 2022 May 27. Affiliations

¹ Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. caswell@stanford.edu.
² Center for Clinical Sciences Research, Stanford University School of Medicine, Room 1145C, Stanford, CA, 94305-5405, USA. caswell@stanford.edu.
³ Dan L Duncan Cancer, Baylor College of Medicine, Houston, TX, USA.
⁴ Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

PMID: 35624175
PMCID: PMC9140322
DOI: 10.1007/s10549-022-06634-z

Item in Clipboard

Abstract

Purpose: The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic.

Methods: Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in the later part of the COVID pandemic.

Results: Average monthly breast cancer incidence was 19.3 (95% CI 19.1-19.5) cases per 100,000 women and men pre-COVID, 11.6 (95% CI 10.8-12.4) per 100,000 in April-May 2020, and 19.7 (95% CI 19.3-20.1) per 100,000 in June 2020-February 2021. Use of pre-operative systemic therapy was 12.0% (11.7-12.4) pre-COVID, 37.7% (34.9-40.7) for patients diagnosed March-April 2020, and 14.8% (14.0-15.7) for patients diagnosed May 2020-January 2021. The changes in breast cancer incidence across the pandemic did not vary by demographic factors. Use of pre-operative systemic therapy across the pandemic varied by geographic region, but not by area socioeconomic deprivation or race/ethnicity.

Conclusion: In this US-insured population, the dramatic changes in breast cancer incidence and the use of pre-operative systemic therapy experienced in the first 2 months of the pandemic did not persist, although a modest change in the initial management of breast cancer continued.

Keywords: Breast cancer incidence; COVID-19; Insurance claims; Neoadjuvant endocrine; Preoperative endocrine.

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Conflict of interest statement

Dr Caswell-Jin receives research support to her institution from QED Therapeutics and Effector Therapeutics. Dr Shafaee receives research support to her institution from Mirati Therapeutics. The remaining authors declare no conflicts of interest.

Figures
Fig. 1

Monthly breast cancer incidence per…

Fig. 1

Monthly breast cancer incidence per 100,000 people from 2017 to 2021. Month of…

Fig. 1

Monthly breast cancer incidence per 100,000 people from 2017 to 2021. Month of breast cancer diagnosis is shown on the x-axis. The pre-COVID period extends from January 2017 through March 2020, COVID period 1 from April 2020 through May 2020, and COVID period 2 from June 2020 through February 2021. Across the population, breast cancer incidence dropped precipitously in COVID period 1 and recovered to slightly above-normal levels in COVID period 2

Fig. 2

First treatment after breast cancer…

Fig. 2

First treatment after breast cancer diagnosis from 2017 to 2021. Month of breast…

Fig. 2

First treatment after breast cancer diagnosis from 2017 to 2021. Month of breast cancer diagnosis is shown on the x-axis, with first treatment occurring within first 2 months after diagnosis. The pre-COVID period extends from January 2017 through February 2020, COVID period 1 from March 2020 through April 2020, and COVID period 2 from May 2020 through January 2021. Across the population, use of pre-operative systemic therapy, and particularly endocrine therapy, increased acutely in COVID period 1 and recovered, although not fully to pre-pandemic levels, in COVID period 2

Fig. 3

Breast cancer incidence across the…

Fig. 3

Breast cancer incidence across the COVID-19 pandemic by area deprivation and race/ethnicity. a…

Fig. 3

Breast cancer incidence across the COVID-19 pandemic by area deprivation and race/ethnicity. a Average monthly breast cancer incidence across the pandemic by area deprivation. Less-deprived areas correspond to Area Deprivation Index percentiles between 0 and 80%, and most deprived corresponds to Area Deprivation Index percentiles over 80%. b Average monthly breast cancer incidence across the pandemic by race/ethnicity. 95% confidence intervals are shown. Pre-COVID is January 2017 through March 2020, COVID period 1 April 2020 through May 2020, and COVID period 2 June 2020 through February 2021. There were no significant differences in the reduction in breast cancer incidence in COVID period 1 and its recovery in COVID period 2 across Area Deprivation Index or race/ethnicity