||1R03CA267469-01 Interpret this number
||Univ Of North Carolina Chapel Hill
||Impact of the COVID-19 Pandemic on Newly-Diagnosed Breast Cancer
The COVID-19 pandemic resulted in dramatic reductions in use of breast cancer screening and diagnostic
services, with screening mammography plunging by up to 99% at the lowest point. Screening and other
diagnostic delays have the potential to result in shifts in the population distribution of breast cancer
characteristics, resulting in tumors that are larger, higher grade, and more often lymph node positive – all factors
associated with increased breast cancer mortality. In observational studies, these effects were more pronounced
among Black and premenopausal women, suggesting that pandemic-related changes in the distribution of breast
cancer characteristics could worsen existing breast cancer disparities. Despite this emerging evidence, there is
little real-world data that quantifies the magnitude of the delay’s effects on the epidemiology of breast cancer.
This lack of information inhibits the ability to develop systematic, evidence-based interventions that
might reduce excess deaths. Therefore, the objective of this study is to measure the pandemic’s impact on
the epidemiology of breast cancer, using data from 3,780 women diagnosed with breast cancer at University of
North Carolina (UNC) Medical Center, UNC Rex, and Nash UNC hospitals during the pandemic (March 2020-
November 2021), compared to 8,947 breast cancer patients diagnosed at the same hospitals before the
pandemic (March 2015-February 2020). The underlying hypothesis is that overall breast cancer incidence
declined following the pandemic onset, but that among the breast cancers that were diagnosed tumors with poor
prognostic characteristics were over-represented. The hypothesis will be evaluated by pursuing the following
specific aims: (1) evaluating pandemic vs. pre-pandemic changes in breast cancer incidence by comparing
incidence overall and according to prognostic characteristics (e.g., stage at diagnosis, tumor size, tumor grade,
lymph node status, breast cancer subtype); and (2) evaluating pandemic vs. pre-pandemic differences in breast
cancer incidence according to indicators of socioeconomic status (e.g., area deprivation index, health insurance
status) and patient factors associated with breast cancer survival disparities (age, race/ethnicity). These trends
will be evaluated using interrupted time series analysis, a methodologically rigorous approach that allows for the
control of pre-pandemic trends while testing for an effect of the intervention. Patient cancer diagnosis and
personal information will be obtained from hospital cancer registries, which abstract high-quality, standardized
data ~6 months before similar data become publicly available through other sources (e.g., state cancer registry),
allowing for the timely identification of changes in breast cancer incidence patterns. Evaluating the pandemic’s
impact on the epidemiology of breast cancer will facilitate identification of interventions (e.g., modifications to the
diagnostic process, targeting of affected demographic subgroups to decrease loss to follow-up, etc.) to alleviate
the impact of pandemic-related delays in care and reduce the number of excess breast cancer deaths attributable
to the pandemic.
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