When President Richard M. Nixon signed the National Cancer Act into law 50 years ago, cancer was the nation's second leading cause of death. Breast cancer was whispered about, if talked about at all, and treated like a virtual death sentence. Fast forward to the early 1990s. I was a newly minted physician immersed in advanced training in breast cancer surgery. At that time, death rates for breast cancer in the U.S. were declining, even as the rate of new cases continued unabated. This decline was no fluke—it was largely thanks to screening and early detection. The 1992 Mammography Quality Standards Act established federal quality standards, assuring that women in the United States would benefit from early detection of breast cancer. Mammography became a staple of women’s health care.
Today an estimated 3.7 million American women are breast cancer survivors. I have seen thousands of patients over the years for whom screening and early detection of breast cancer have made a dramatic difference. It can mean finding cancer before its cells travel beyond the breast. It can give patients options in surgery, such as a less invasive lumpectomy instead of a mastectomy. But the COVID-19 global pandemic has threatened this breast cancer success story, as the US saw a significant drop in breast cancer screening during the pandemic.
Mammography and other preventive health screenings took a back seat to combat COVID-19. Hospitals canceled or postponed elective procedures, including cancer screenings such as mammograms, as they focused on the struggle against a highly contagious, life-threatening virus. Women of ethnic and racial minority groups saw the steepest declines in testing. One CDC study determined that the total number of cancer screening tests received through CDC’s National Breast and Cervical Cancer Early Detection Program, which addresses underserved women, declined by 87 percent for breast cancer and 84 percent for cervical cancer during April 2020 as compared with the previous 5-year averages for that month.
Another study in the Journal of the National Cancer Institute looked at mammography utilization for screening (no symptoms) and for diagnosing (where symptoms exist) during the first five months of the COVID-19 pandemic. The study found that in 2019, an average of 28,000 screening mammograms and 6,500 diagnostic mammograms were done per month at the 62 radiology facilities they examined. By contrast, only 317 screening mammograms were done in April 2020, about 1 percent of what was done in April 2019. For women with symptoms, only 1,452 diagnostic mammograms were done in April 2020, about 21 percent of what was done in April 2019.
By June 2020, diagnostic mammograms were back up to about 98 percent of pre-pandemic levels, but screening mammogram rates were slower to rebound. They gradually increased to about 90 percent of pre-pandemic rates by July 2020.
These studies underscore the need to safely maintain routine health care services, including mammography and other cancer screenings, during a pandemic. As a physician and as the chair of the President’s Cancer Panel, I am concerned that postponed cancer screenings will lead to more diagnoses at later stages and ultimately lead to more deaths. For breast cancer screening, those harmed the most by this disruption are diverse groups, particularly women of color. The President’s Cancer Panel’s upcoming report slated for release in early 2022 will include recommendations for improving access to cancer screening and closing these gaps.
As we make note of our lessons learned from the pandemic, we all must adapt and innovate to expand equitable access to life-saving screenings and diagnostics for cancer. We cannot afford to let down our guard. The time to stem this tide is now. The public health community must mobilize to ensure that we do not let such disruptions to potentially life-saving cancer screening ever happen again.
John P. Williams, MD, FACS is the Chair of the President’s Cancer Panel, an independent entity charged with monitoring the National Cancer Program and reporting annually to the President of the United States. Dr. Williams is a founding physician of the Novant Health UVA Breast Center, a national leader in breast cancer education, and founder of the not-for-profit Breast Cancer School for Patients.