A team of researchers led by Dr. Brian Sprague from the University of Vermont found that screening services were most severely impacted, though more than half of facilities also reported disruptions to diagnostic imaging and biopsy services.
The group also found that facilities prioritized urgent breast imaging services based on examination indication, while also highly prioritizing rescheduling of canceled appointments.
"Prioritizing scheduling based on canceled examinations may have resulted in scheduling individuals at low breast cancer risk sooner than those at higher risk," the study authors wrote.
Breast cancer screening and diagnostic imaging services were disrupted during the pandemic, with most states issuing emergency executive orders barring elective medical procedures by April 2020. Mammography screening plummeted by more than 90% during April, with diagnostic mammography decreasing by as much as 80%, the researchers said.
"These impacts raised widespread concerns about delays in breast cancer diagnosis and adverse impacts on breast cancer mortality, underscoring the importance of resuming services as quickly as could be safely accomplished," they wrote.
Breast imaging facilities meanwhile faced challenges in providing services while ensuring safety for patients, radiology staff, and providers. In the current paper, Sprague and colleagues wanted to see how facilities modified their services during the COVID-19 pandemic and how they prioritized women for different types of examinations during periods of limited capacity or upon reopening.
The team surveyed 77 breast imaging facilities in the U.S. The survey gathered information on how the pandemic impacted clinical practices from March to September 2020.
About 97% of facilities reported closing or operating at reduced capacity at some point during this period. While facilities largely recovered by September 2020, with all reopening by August, about 14% were still operating at reduced capacity in September.
Prioritization of breast imaging, screening, patients seen first, and biopsy services differed among facilities during periods of reopening or reduced capacity. About 93% of facilities reported prioritizing diagnostic breast imaging over breast cancer screening.
For diagnostic imaging, facilities prioritized based on rescheduling canceled appointments (89%), specific indication for diagnostic imaging (89%), patient demand (84%), individual characteristics and risk factors (77%), and time since last imaging examination (72%).
For screening mammography, facilities prioritized rescheduled cancelations (96%), patient demand (83%), individual characteristics and risk factors (73%), and time since the last mammogram (71%).
For biopsy services, more than 90% of facilities reported prioritization based on rescheduling of canceled exams, patient demand, patient characteristics and risk factors, and level of suspicion on imaging.
The research team said the results were not surprising and that logistical challenges may have prevented further expansion of breast imaging services.
"It is also possible that concerns about personal risk of exposure to COVID-19 reduced the availability of staff and radiologists, particularly for performing biopsies during which physical distancing is not possible," the group wrote.
While shared decision-making and communication among patients, radiologists, and referring clinicians would be a preferred pathway to prioritizing higher-risk patients, Sprague and colleagues said this would have been challenging during the pandemic. They noted that prioritizing rescheduling appointments was an easier way to identify patients.
The researchers said that facilities can develop strategies to support care and service goals in future times of capacity restriction, such as another pandemic. This includes evaluating facility-level outcomes in relation to prioritization strategies and discussing guiding principles for prioritization.
They also said additional studies are needed to assess facility-level barriers to implementing tailored risk-based prioritization strategies.
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