A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis

Tong Li; Brooke Nickel; Preston Ngo; Kathleen McFadden; Meagan Brennan; M Luke Marinovich; Nehmat Houssami

doi:10.1016/j.breast.2023.01.001

A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis

Breast. 2023 Feb:67:78-88. doi: 10.1016/j.breast.2023.01.001. Epub 2023 Jan 5.

Authors

Tong Li¹, Brooke Nickel², Preston Ngo³, Kathleen McFadden³, Meagan Brennan⁴, M Luke Marinovich⁵, Nehmat Houssami⁵

Affiliations

¹ The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: t.li@sydney.edu.au.
² School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
⁴ Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia.
⁵ The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Background: Breast cancer care has been affected by the COVID-19 pandemic. This systematic review aims to describe the observed pandemic-related changes in clinical and health services outcomes for breast screening and diagnosis.

Methods: Seven databases (January 2020-March 2021) were searched to identify studies of breast cancer screening or diagnosis that reported observed outcomes before and related to the pandemic. Findings were presented using a descriptive and narrative approach.

Results: Seventy-four studies were included in this systematic review; all compared periods before and after (or fluctuations during) the pandemic. None were assessed as being at low risk of bias. A reduction in screening volumes during the pandemic was found with over half of studies reporting reductions of ≥49%. A majority (66%) of studies reported reductions of ≥25% in the number of breast cancer diagnoses, and there was a higher proportion of symptomatic than screen-detected cancers. The distribution of cancer stage at diagnosis during the pandemic showed lower proportions of early-stage (stage 0-1/I-II, or Tis and T1) and higher proportions of relatively more advanced cases than that in the pre-pandemic period, however population rates were generally not reported.

Conclusions: Evidence of substantial reductions in screening volume and number of diagnosed breast cancers, and higher proportions of advanced stage cancer at diagnosis were found during the pandemic. However, these findings reflect short term outcomes, and higher-quality research examining the long-term impact of the pandemic is needed.

Keywords: Breast cancer; COVID-19; Diagnosis; Mammography; Pandemic; Screening.

Publication types

Systematic Review
Review

MeSH terms

Breast Neoplasms* / diagnosis
Breast Neoplasms* / epidemiology
COVID-19 Testing
COVID-19* / diagnosis
COVID-19* / epidemiology
Early Detection of Cancer
Female
Humans
Neoplasm Staging
Pandemics