Article

3 Things Experts Are Saying About Mammography During the COVID-19 Crisis

According to the United States Food & Drug Administration (FDA) and Division of Mammography Quality Standards, approximately 40 million mammograms are performed in the U.S. every year.1 That’s more than 100,000 a day.

In response to the COVID-19 crisis, the number of mammograms performed daily has dropped drastically. Most breast centers are seeing only a fraction of the patients they would normally see. It’s too soon yet to predict the full impact of COVID-19 on breast imaging and women’s health, but a few facts have emerged:

Screening mammograms are on hold indefinitely

Health experts agree: cancellation of non-essential healthcare services is the best way, at present, to protect staff and prevent further spread of the novel coronavirus.

The American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers), the National Comprehensive Cancer Network (NCCN), the Commission on Cancer (CoC) of the American College of Surgeons, and the American College of Radiology ACR) all support suspending screening mammography (as well as screening ultrasound scans and MRIs) “until the post-COVID-19 period,” according to a joint statement released on April 13, 2020.2

Diagnostic mammograms are allowed and encouraged, although breast imaging centers have already noted a decline in diagnostic mammograms because almost no screening mammograms have been performed since mid-March.This shift is already taking place in the field.

“Our core focus as we look towards recovery is to provide an essential imaging environment that Patients and Technologists feel safe in," said Gary Dee, MD, FACR, Chair, Hartford Healthcare Radiology Council, and President, Midstate Radiology Associates, LLC.

Recommendations may evolve as the Covid-19 crisis continues. According to the April 13 joint statement, screening mammograms of BRCA mutation carriers under the age of 40 may be considered if delays of more than six months are expected4.

Follow the American College of Radiology, the American Society of Breast Surgeons and the Centers for Disease Control and Prevention (CDC) for updated information. The Journal of the American College of Radiology also maintains a list of Covid-19 resources, including articles and webinars.

The risk/benefit ratio has been recalculated

Two facts have dramatically reshaped mammography risk/benefit calculations:

Asymptomatic people may be unknowing carriers of COVID-19.

An article in Science suggests that undocumented COVID-19 cases were responsible for 86 percent of the spread of the disease in China before the country enacted travel restrictions in late January.5 At the end of March, CDC director Dr. Robert Redfield told NPR that as many 25% on novel coronavirus-infected patients may be asymptomatic but capable of spreading the disease to others.6

The health of doctors and technologists must be preserved to prevent shortages of healthcare providers.

Given anticipated COVID-19-related surges in demand for medical care, healthcare organizations are taking drastic steps – including the cancellation of elective surgeries and screening mammograms – to reduce potential staff exposure to SARS-CoV-2, the virus that causes COVID-19.

In a manuscript accepted for publication by The Journal of Breast Imaging, Mary S. Newell, MD, FACR, a radiologist with Emory University Health System writes, “We as breast imaging radiologists have worked our entire careers to address the immediate needs of our individual patients, to assuage their fears and expedite their care. How disconcerting it is for us to now be faced with a new take on the risk vs. benefit equation.”7

There will be pent-up demand as the COVID-19 crisis winds down

Each day, another 100,000 or so screening mammograms are added to the backlog. Experts expect tremendous demand for mammography after COVID-19-related restrictions are lifted; they also expect that some women will hesitate to return to medical facilities, due to fear of possible virus exposure. Thus, some experts are taking innovative approaches to reassure patients that essential procedures can be done safely now.

“From scripting to community education to redefined check-in processes, we feel really confident that we can increase the trajectory in making things better for our patients in getting these crucial diagnostic tests again," said Tom Cappas, MBA, MS, RTR MR, Director Of Radiology, Hartford HealthCare, Central Region.

Experts are urging breast cancer centers to begin planning now to meet pent-up demand. At Emory, professionals are triaging patients whose mammograms were delayed; patients with lesions classified BiRADS category 3 and 4 will be prioritized over asymptomatic patients who missed routine screening mammograms.8

Some facilities are also making plans to offer extended hours, including evening and weekend appointments, until demand once again levels off to typical levels.9 Creative thinking will be required to figure out how to safely meet the needs of both patients and providers.

“We’ve come such a long way in preventative medicine in imaging, that as we pivot to the recovery efforts, we need to really manage the emotional response of our patients," said Cappas. "Making them feel comfortable coming back for these vital and necessary imaging tests.”

For more information on mammography and women's health, visit gehealthcare.com/mammography.

RESOURCES

  1. MQSA National Statistics. U.S. Food & Drug Administration. https://www.fda.gov/radiation-emitting-products/mqsa-insights/mqsa-national-statistics Accessed April 16, 2020.
  2. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx Accessed April 15, 2020.
  3. Response to COVID-19 in Breast Imaging. Journal of Breast Imaging. https://academic.oup.com/jbi/article/doi/10.1093/jbi/wbaa025/5814656 Accessed April 16, 2020.
  4. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx Accessed April 15, 2020.
  5. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science. https://science.sciencemag.org/content/early/2020/03/24/science.abb3221.full Accessed April 16, 2020.
  6. CDC Director On Models For The Months To Come: 'This Virus Is Going To Be With Us.’ NPR. https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us Accessed April 16, 2020.
  7. Response to COVID-19 in Breast Imaging. Journal of Breast Imaging. https://academic.oup.com/jbi/article/doi/10.1093/jbi/wbaa025/5814656 Accessed April 16, 2020.
  8. Response to COVID-19 in Breast Imaging. Journal of Breast Imaging. https://academic.oup.com/jbi/article/doi/10.1093/jbi/wbaa025/5814656 Accessed April 16, 2020.
  9. Response to COVID-19 in Breast Imaging. Journal of Breast Imaging. https://academic.oup.com/jbi/article/doi/10.1093/jbi/wbaa025/5814656 Accessed April 16, 2020.