Pandemic Impact on Breast Cancer Screening and Health Maintenance

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The goal of the WISDOM study is to compare 2 approved screening approaches, annual mammograms for all women, starting at the age of 40 years, or a personalized approach to breast screening that is based on specific individual risk factors for breast cancer, such as a woman’s breast density, family health history, and genes.1 It will enroll >40,000 healthy women and will compare outcomes from traditional annual screening with outcomes from personalized risk-based breast cancer screening. Female participants ranging from 40 to 74 years of age, who have no history of breast cancer or ductal carcinoma in situ, and who have no previous double mastectomy, will be able to participate in the WISDOM study online at www.wisdomstudy.org.

To date, 28,600 women have agreed to participate. Individual patients will complete a baseline evaluation and interval surveys as part of the trial.

During the COVID-19 pandemic, cancer screening, routine healthcare, and elective procedures have been disrupted as providers tried to manage and allocate limited resources. There is a growing recognition that to fully understand the effect of the pandemic on healthcare activities, researchers must take into consideration the clinical impact of COVID-19 on decision-making and clinical trial participants. Therefore, in May 2020, a COVID-specific survey was amended to the original WISDOM study, with questions related to participants’ COVID risk perceptions, coexisting conditions, and receipt of healthcare services in the 2 months prior to the survey. At that time, an initial survey was sent with follow-up surveys planned for every 2 months. Furthermore, cross-sectional analyses based on national surveys will be completed in parallel.

Collected data were deidentified, and then examined using basic descriptive, chi-squared, and logistic regression analysis.

To date, a total of 7523 individuals have responded to the WISDOM survey, yielding a response rate of 27%; at the time of the survey, the average age of respondents was 59 years, ranging from 40 to 79 years of age.

The majority of patients were Caucasian (87%), while 6% were Hispanic, and 4% were African American. Although 3.6% of the study population reported they had COVID-19 either by symptoms or through testing, 10% thought they were at higher risk compared with similar individuals in their age-group. Nearly one-third (29%) of the study participants reported some form of high-risk comorbidity.

In terms of healthcare use, 43% of participants had a routine primary care medical visit canceled by their provider or healthcare system, and >26% canceled an appointment themselves in the previous 2 months. Canceling or rescheduling of appointments occurred for breast cancer screening in 16% of patients. Participants who believed they were at higher risk, and thus felt more likely to have shorter-interval screening recommendations during this trial, had a higher odds ratio (OR, 1.66) for a cancellation of screening (P <.001). On the other hand, patients were more likely to undergo routine medical visits and care in the preceding 2 months if they believed COVID-19 was no more dangerous than the seasonal flu, when compared with those patients who did not share that belief (OR, 1.18; P = .032). Overall, participant concern about COVID-19 caused significantly more anxiety than breast cancer; 43% of participants expressed moderate to severe concern about COVID-19 compared with 8.2% for breast cancer. Those who were more worried about breast cancer were less likely to have a screening cancellation (OR, 0.83; P <.001) compared with those patients who were more worried about COVID-19 (OR, 1.18; P <.001).

At the time of abstract publication and presentation in December 2020, the investigators suggested and astutely projected that until there is a vaccine, treatment, or herd immunity, the pandemic will likely continue for many months. They highlighted that it will be critical to define the treatment drivers and barriers, as well as critical clinical messages (eg, healthcare and screening), to ensure patients receive proper health maintenance and prevention to reduce the risks associated with other diseases that are not COVID-19.

Source:

Naeim A, Wenger N, Sepucha K, et al. Health maintenance and breast cancer screening during the COVID-19 pandemic. Presented at 2020 San Antonio Breast Cancer Symposium, December 8-11, 2020. SS2-04.

Reference

  1. Esserman LJ, WISDOM Study and Athena Investigators. The WISDOM study: breaking the deadlock in the breast cancer screening debate. NPJ Breast Cancer. 2017;3:34.

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