Better Late Than Never: Breast Cancer Screenings Drop, Leading To More Later-Stage Diagnoses

Dr. Edna Kapenhas. DANA SHAW

Over the last 15 years, Lucia’s Angels has helped women and their families on the East End navigate stage-four women’s cancers — from providing emotional and financial support to hosting exercise classes to offering a comfortable place for patients to recover after difficult surgeries.

For the first time since the start of the COVID-19 pandemic, the foundation is busier than ever.

As hospitals have returned to a sense of normalcy, so have routine breast cancer screenings, largely put on pause by many women during the height of the pandemic — in some cases, leading to more serious cancer diagnoses as a result, explained Stacy Quarty, president of Lucia’s Angels, who noted that she’s seen a dramatic uptick of patients in recent months.

“Since people are starting to go back and get their mammograms, we are seeing some later-stage cancers being diagnosed now, because people had delayed,” Ms. Quarty said. “We actually had a Zoom conference with all of the breast health coalitions on Long Island during COVID, and lots of them were saying they were thinking this was going to happen.”

She sighed. “We are seeing it happening, we don’t have any numbers yet, but I think the next year or so is gonna be really telling, as far as these numbers going up.”

According to the Centers for Disease Control and Prevention, its National Breast and Cervical Cancer Early Detection Program saw an 87-percent decline in breast cancer screenings during April 2020, as compared with the previous five-year averages for that month — a trend that Dr. Edna Kapenhas described as “striking” and expects is mirrored on the East End.

“Now that we’re back to pre-pandemic — at least in most areas — we’re probably gonna start seeing a bigger surge of cancers,” the director of breast surgery and medical director of the Ellen Hermanson Breast Center at Stony Brook Southampton Hospital reported. “We’re already seeing more advanced cancers. It’s a real thing. I have seen that some people are showing up with larger tumors.”

At the beginning of the pandemic, most hospitals around the world delayed or canceled elective procedures, including screening mammograms, to help prevent people from coming in contact with COVID-19, and to make space for patients who were already infected with the virus.

With strict safety procedures still in place, healthcare facilities have reopened for breast cancer screenings and, starting in June 2020, exam rates buoyed back up — and, along with them, long overdue diagnoses.

“We had a couple of ladies who had suspicious lumps on their breasts,” Ms. Quarty said, “and then when they were able to go in and get tested and get their mammograms, that’s when they saw it was a later-stage cancer — and it’s too bad they couldn’t get in earlier.”

Outside of the fear of contracting the virus, the pandemic itself created a trickle-down effect that prevented some women from their screenings. For those who lost their jobs, they may have lost their health insurance, too. And for those with children, school closures pushed childcare back on parents, limiting their time and access to healthcare — a threat to existing health disparities, Dr. Kapenhas said.

Even larger declines were seen among different ethnic and socio-economic groups, she explained, quoting the CDC study: Breast cancer screenings dipped 84 percent among Hispanic women and 98 percent among American Indian/Alaskan Native women, and the number of tests dropped by 86 percent in metro areas, 88 percent in urban areas and 89 percent in rural settings.

“The volume started recovering in June in all the groups, but at that time, researchers were thinking, ‘Well, this decline is probably going to result in delayed diagnosis, potentially contribute to poorer outcomes and, also, increase whatever disparities exist among these different groups,’” Dr. Kapenhas said, “which it did.”

During last year’s San Antonio Breast Cancer Symposium, a study that observed patients within the Kaiser Permanente healthcare system — comparing patients between March and May 2020 to those who visited between March and May 2019 — found that to be true, Dr. Kapenhas said.

“The patients that were diagnosed with breast cancer in 2020,” she said, “more of them presented with symptomatic disease, with more advanced cancer, larger tumor sizes, perhaps more metastases and more aggressive biology of the cancer. It’s kind of scary, unfortunately.”

Looking ahead, a predictive model of breast cancer mortality in England recently estimated a 7.9 to 9.6 increase in the number of deaths due to breast cancer up to year five after diagnosis, reported Dr. Kapenhas, adding that early detection is the best way to run interference.

“The risks of not having the screening is much higher than the risk of, ‘Oh, I’m going to catch COVID if I go for my mammogram,’” she said. “A year is a long time that things can develop. I strongly advise them not to skip their screening and to continue, because it really can be a lifesaver.”

Early detection can mean the difference between stage one and stage four cancer, between needing a lumpectomy, a mastectomy, or radiation.

And, post-pandemic, it’s better late than never, Ms. Quarty said.

“Thinking about getting back to that kind of thing and taking care of your health maybe is not number-one on a lot of people’s lists because they’re like, ‘Let’s go out and socialize, let’s go out and party, let’s go out and travel. Those are my number-ones right now,’” she said. “But early detection is the key, and if everyone could try to get back into the habit of getting that annual mammogram on the calendar, it’s really important.”