Influence of the COVID-19 pandemic on breast cancer outcomes: A microsimulation model of the National Mammography Database.

Abstract

This study aimed to evaluate the impact of the COVID-19 pandemic on screening patterns from a large, diverse, nationally representative breast cancer screening registry and to perform microsimulation modeling of breast cancer outcomes. Retrospective breast imaging and outcomes data from the National Mammography Database (NMD) from January 2017 through December 2022 were collected and partitioned into pre-COVID, peak-COVID, and post-COVID time periods. Microsimulation modeling was performed to predict breast cancer outcomes, including the cancer stage distribution, excess breast cancer deaths, and years of life lost from 2020 to 2065. There were 12,118,324 screening exams, 1,211,754 screening recalls, 194,096 biopsies, and 55,732 cancer diagnoses included for analysis. There was an acute drop in all metrics in 2020, and these metrics did not approach pre-COVID levels until 2022. This corresponded with a significant increase in the time interval between screening exams between the pre-COVID and post-COVID periods (16.3±7.7 vs. 17.8±9.3 months respectively; p<0.001). Simulations predicted that, by 2030, 12% more late-stage cancers would be diagnosed. The estimated cumulative excess deaths following peak-COVID were 6.7 per 100,000 women by 2030, an increase of 0.40%, increasing to 16.8 (0.51%) excess deaths by 2040. The corresponding number of years of life lost by 2065 was 565 per 100,000 women screened. The interruption in screening during peak-COVID and the slow return to pre-COVID screening levels may have resulted in an increase in late-stage cancers, excess cancer deaths, and years of life lost.