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Robles C, Monfil L, Ibáñez R, Roura E, Font R, Peremiquel-Trillas P, Brotons M, Martínez-Bueno C, de Sanjosé S, Espinàs JA, Bruni L. Impact of the COVID-19 pandemic on cervical cancer screening participation, abnormal cytology prevalence and screening interval in Catalonia. Front Oncol 2024; 14:1338859. [PMID: 38873256 PMCID: PMC11171128 DOI: 10.3389/fonc.2024.1338859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Background The COVID-19 pandemic led to a national lockdown and the interruption of all cancer preventive services, including cervical cancer screening. We aimed to assess the COVID-19 pandemic impact on opportunistic screening participation, abnormal cytology (ASCUS+) prevalence and screening interval in 2020 and 2021 within the Public Health System of Catalonia, Spain. Methods Individual data on cytology and HPV testing of women aged 25-65 from 2014 to 2021 were retrieved from the Information System for Primary Care Services (SISAP). Time-series regression models were used to estimate expected screening participation and abnormal cytology prevalence in 2020 and 2021. The impact was determined by comparing observed and expected values (ratios). Additionally, changes in screening interval trends between 2014 and 2021 were assessed by fitting a Piecewise linear regression model. Results Cervical cancer screening participation decreased by 38.8% and 2.2% in 2020 and 2021, respectively, with the most significant impact on participation (-96.1%) occurring in April 2020. Among older women, participation was lower, and it took longer to recover. Abnormal cytology prevalence was 1.4 times higher than expected in 2020 and 2021, with variations by age (range=1.1-1.5). From June 2020 onwards, the screening interval trend significantly changed from an increase of 0.59 to 3.57 months per year, resulting in a median time of 48 months by December 2021. Conclusions During the pandemic, fewer women have participated in cervical cancer screening, abnormal cytology prevalence has increased, and the screening interval is more prolonged than before. The potential cervical cancer lifetime risk implications highlight the need for organized HPV-based screening.
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Affiliation(s)
- Claudia Robles
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Monfil
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Ibáñez
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Esther Roura
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Rebeca Font
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain
| | - Paula Peremiquel-Trillas
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Maria Brotons
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Cristina Martínez-Bueno
- University of Barcelona, Barcelona, Spain
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Catalunya, Institut Català de la Salut, Barcelona, Spain
- Grup de Recerca en Salut Sexual i Reproductiva (GRASSIR), Barcelona, Spain
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Institut de Salut Global (ISGlobal), Barcelona, Spain
| | | | - Laia Bruni
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
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Wang H, Yang M, Xiong W, Wang Q, Zheng B, Bai Y, Zou K, Li J, Ren J, Chen W, Zhai J, Li J. Noteworthy impacts of COVID-19 pandemic on cancer screening: A systematic review. FUNDAMENTAL RESEARCH 2024; 4:484-494. [PMID: 38933198 PMCID: PMC11197616 DOI: 10.1016/j.fmre.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 06/28/2024] Open
Abstract
The sudden onset of the coronavirus disease 2019 (COVID-19) in January 2020 has affected essential global health services. Cancer-screening services that can reduce cancer mortality are strongly affected. However, the specific role of COVID-19 in cancer screening is not fully understood. This study aimed to assess the efficiency of global cancer screening programs before and during the COVID-19 pandemic and to promote potential cancer-screening strategies for the next pandemic. Electronic searches in PubMed, Embase, and Web of Science, and manual searches were performed between January 1, 2020 and March 1, 2023. Cohort studies that reported the number of participants who underwent cancer screening before and during the COVID-19 pandemic were included. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Differences in cancer-screening rates were estimated using the incidence rate ratio (IRR). Fifty-five cohort studies were included in this meta-analysis. The screening rates of colorectal cancer using invasive screening methods (Pooled IRR = 0.52, 95% CI: 0.42 to 0.65, p < 0.01), cervical cancer (Pooled IRR = 0.56, 95% CI: 0.47 to 0.67, p < 0.01), breast cancer (Pooled IRR = 0.57, 95% CI: 0.49 to 0.66, p < 0.01) and prostate cancer (Pooled IRR = 0.71, 95% CI: 0.56 to 0.90, p < 0.01) during the COVID-19 pandemic were significantly lower than those before the COVID-19 pandemic. The screening rates of lung cancer (Pooled IRR = 0.77, 95% CI: 0.58 to 1.03, p = 0.08) and colorectal cancer using noninvasive screening methods (Pooled IRR = 0.74, 95% CI: 0.50 to 1.09, p = 0.13) were reduced with no statistical differences. The subgroup analyses revealed that the reduction in cancer-screening rates varied across economies. Our results suggest that the COVID-19 pandemic has had a noteworthy impact on colorectal, cervical, breast, and prostate cancer screening. Developing innovative cancer-screening technologies is important to promote the efficiency of cancer-screening services in the post-COVID-19 era and prepare for the next pandemic.
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Affiliation(s)
- Huilin Wang
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Min Yang
- Department of Comprehensive Intervention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei Xiong
- Department of Gynecology Endocrine & Reproductive Center, National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Quan Wang
- Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi'an 710068, China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People’ s Hospital, Xi'an 710068, China
| | - Yang Bai
- College of Clinical Medicine, Capital Medical University, Beijing 100069, China
| | - Kaiyong Zou
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jibin Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiansong Ren
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jingbo Zhai
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jiang Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Cohen EO, Edelkamp P, Sun J, Leung JWT. Breast Imaging Patient Demographics at a Major Comprehensive Cancer Center Before and During the COVID-19 Pandemic. J Am Coll Radiol 2024; 21:576-588. [PMID: 37952808 DOI: 10.1016/j.jacr.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The coronavirus disease of 2019 (COVID-19) pandemic disproportionately affected certain vulnerable communities. The purpose of our study was to determine how COVID-19 affected the socioeconomic demographics of breast imaging patients at a major comprehensive cancer center. METHODS This retrospective cohort study compared female patients who underwent screening mammograms, diagnostic mammograms, breast ultrasound, or breast MRI during the following time periods: prepandemic (February 1, 2018, through February 29, 2020), acute pandemic (March 1, 2020, through June 30, 2020), subacute pandemic (August 1, 2020, through December 31, 2020), and chronic pandemic (January 1, 2021, through June 30, 2022). Statistics were performed using the generalized estimating equations approach. RESULTS A total of 74,398 female patients (mean age, 55.6 ± 12.4 years) underwent 238,776 total breast imaging examinations. For screening mammograms, Hispanics represented 27.1% (9,197 of 33,960) of patients in the prepandemic time period compared with 16.7% (604 of 3,621) in the acute pandemic time period, 18.7% (1,835 of 9,830) in the subacute pandemic time period, and 24.3% (7,492 of 30,869) in the chronic pandemic time period (all P < .0001). Self-pay patients saw similar declines for screening mammograms during the same time periods: 21.7% (7,375 of 33,960), 7.9% (286 of 3,621), 9.5% (933 of 9,830), and 17.4% (5,357 of 30,869), respectively (all P < .0001, compared with the prepandemic time period). Similarly dramatic trends were not observed for race or other imaging examinations. DISCUSSION At our cancer center, Hispanics and self-pay patients were disproportionately affected by the COVID-19 pandemic. Strategies to improve health inequities are needed.
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Affiliation(s)
- Ethan O Cohen
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Paul Edelkamp
- Division of Information Services, Enterprise Data Engineering, and Analytics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jessica W T Leung
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Deputy Chair, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Marty S, Lamé G, Guével E, Priou S, Chatellier G, Tournigand C, Kempf E. Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis. BMC Cancer 2024; 24:143. [PMID: 38287348 PMCID: PMC10823607 DOI: 10.1186/s12885-023-11795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/25/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic might have delayed cancer diagnosis and management. The aim of this systematic review was to compare the initial tumor stage of new cancer diagnoses before and after the pandemic. METHODS We systematically reviewed articles that compared the tumor stage of new solid cancer diagnoses before and after the initial pandemic waves. We conducted a random-effects meta-analysis to compare the rate of metastatic tumors and the distribution of stages at diagnosis. Subgroup analyses were performed by primary tumor site and by country. RESULTS From 2,013 studies published between January 2020 and April 2022, we included 58 studies with 109,996 patients. The rate of metastatic tumors was higher after the COVID-19 outbreak than before (pooled OR: 1.29 (95% CI, 1.06-1.57), I2: 89% (95% CI, 86-91)). For specific cancers, common ORs reached statistical significance for breast (OR: 1.51 (95% CI 1.07-2.12)) and gynecologic (OR: 1.51 (95% CI 1.04-2.18)) cancers, but not for other cancer types. According to countries, common OR (95% CI) reached statistical significance only for Italy: 1.55 (1.01-2.39) and Spain:1.14 (1.02-1.29). Rates were comparable for stage I-II versus III-IV in studies for which that information was available, and for stages I-II versus stage III in studies that did not include metastatic patients. CONCLUSIONS Despite inter-study heterogeneity, our meta-analysis showed a higher rate of metastatic tumors at diagnosis after the pandemic. The burden of social distancing policies might explain those results, as patients may have delayed seeking care.
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Affiliation(s)
- Simon Marty
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Guillaume Lamé
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Etienne Guével
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, Paris, France
| | - Sonia Priou
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, F-75015, Paris, France
| | - Christophe Tournigand
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Emmanuelle Kempf
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France.
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
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Sahakyan S, Muradyan D, Giloyan A, Harutyunyan T. Factors associated with delay or avoidance of medical care during the COVID-19 pandemic in Armenia: results from a nationwide survey. BMC Health Serv Res 2024; 24:20. [PMID: 38178214 PMCID: PMC10768194 DOI: 10.1186/s12913-023-10483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems throughout the world. Many patients faced delays and cancellation of care due to scaled back services, mobility restrictions, and concerns related to the risk of infection. The present study aimed to assess the prevalence of and risk factors associated with the avoidance or delay of medical care due to COVID-19 in Armenia. METHODS We conducted a cross-sectional telephone survey of 3,483 adults across Armenia. We used stratified two-stage cluster sampling to select the participants from different age groups proportionate to their size in the population. Logistic regression analysis assessed the association of risk factors with avoidance/delay of routine, urgent/emergency, and any medical care. RESULTS The mean age of the sample was 49.5 (SD = 14.8), ranging from 18 to 90. About 9.9% of the respondents avoided/delayed any type of medical care; whereas 5.5% avoided/delayed urgent/emergency care and 6.6% routine care. In the adjusted analysis, female gender and higher monthly expenditures were associated with avoidance/delay of routine medical care. Factors associated with delay/avoidance of urgent/emergency care included female gender and higher perceived threat of COVID-19. Younger age, female gender, higher perceived threat and not being vaccinated against COVID-19 were associated with avoidance/delay of any medical care in the adjusted analysis. CONCLUSION Since avoiding or delaying care might increase morbidity and mortality associated with conditions not related to COVID-19, identifying population groups that are more likely to avoid care is important. Targeting such groups with educational interventions focusing on the risks of using versus not using medical care in times of pandemic might be crucial. Ensuring the provision of in-home healthcare services for high-risk groups might help to address important medical care needs during the pandemic.
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Affiliation(s)
- Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| | - Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia.
| | - Aida Giloyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| | - Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
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Portero de la Cruz S, Béjar LM, Cebrino J. Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020). Healthcare (Basel) 2023; 11:2934. [PMID: 37998426 PMCID: PMC10671473 DOI: 10.3390/healthcare11222934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain
- Research Group GE10 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain
| | - Luis M. Béjar
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
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Guével E, Priou S, Lamé G, Wassermann J, Bey R, Uzan C, Chatellier G, Belkacemi Y, Tannier X, Guillerm S, Flicoteaux R, Gligorov J, Cohen A, Benderra M, Teixeira L, Daniel C, Hersant B, Tournigand C, Kempf E. Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study. Cancer Med 2023; 12:20918-20929. [PMID: 37909210 PMCID: PMC10709737 DOI: 10.1002/cam4.6637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic. METHODS We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020. RESULTS In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups. CONCLUSIONS Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.
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Affiliation(s)
- Etienne Guével
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Sonia Priou
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Guillaume Lamé
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Johanna Wassermann
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
| | - Romain Bey
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Catherine Uzan
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of gynecology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre‐Université de Paris (APHP‐CUP)Université Paris CItéParisFrance
| | - Yazid Belkacemi
- Assistance Publique–Hôpitaux de Paris, Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Xavier Tannier
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Sophie Guillerm
- Assistance Publique–Hôpitaux de Paris, Department of radiation therapy, Saint Louis University HospitalUniversité Paris CitéCréteilFrance
| | - Rémi Flicoteaux
- Assistance Publique–Hôpitaux de ParisDepartment of medical informationParisFrance
| | - Joseph Gligorov
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Ariel Cohen
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Marc‐Antoine Benderra
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Luis Teixeira
- Assistance Publique–Hôpitaux de Paris, Department of senology, Saint Louis Teaching HospitalUniversité Paris CitéParisFrance
| | - Christel Daniel
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Barbara Hersant
- Assistance Publique – Hôpitaux de Paris, Department of plastic surgery, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Christophe Tournigand
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Emmanuelle Kempf
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
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Ayala de la Peña F, Antolín Novoa S, Gavilá Gregori J, González Cortijo L, Henao Carrasco F, Martínez Martínez MT, Morales Estévez C, Stradella A, Vidal Losada MJ, Ciruelos E. SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022). Clin Transl Oncol 2023; 25:2647-2664. [PMID: 37326826 PMCID: PMC10425528 DOI: 10.1007/s12094-023-03215-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. Thanks to the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages, despite the COVID-19 pandemic possibly having impacted these numbers (not yet quantified). In recent years, locoregional and systemic therapies are increasingly being directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody-drug conjugates have also improved outcomes in some patient subgroups. This clinical practice guideline is based on a systematic review of relevant studies and on the consensus of experts from GEICAM, SOLTI, and SEOM.
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Affiliation(s)
- Francisco Ayala de la Peña
- Department of Medical Oncology, Hospital G. Universitario Morales Meseguer, University of Murcia, Av. Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Silvia Antolín Novoa
- Department of Medical Oncology, Complexo Hospitalario Universitario, A Coruña (CHUAC), Coruña, Spain
| | | | | | | | - María Teresa Martínez Martínez
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico of Valencia, University of Valencia, 46010, Valencia, Spain
| | | | - Agostina Stradella
- Medical Oncology Department, Institut Català d'Oncologia. L'Hospitalet,, Barcelona, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain and HM Hospitales, Madrid, Spain
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Olesen TB, Jensen H, Møller H, Jensen JW, Andersen B, Vejborg I, Njor SH. Nationwide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study. eLife 2023; 12:e83541. [PMID: 37589381 PMCID: PMC10513477 DOI: 10.7554/elife.83541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
Background In most of the world, the mammography screening programmes were paused at the start of the pandemic, whilst mammography screening continued in Denmark. We examined the mammography screening participation during the COVID-19 pandemic in Denmark. Methods The study population comprised all women aged 50-69 years old invited to participate in mammography screening from 2016 to 2021 in Denmark based on data from the Danish Quality Database for Mammography Screening in combination with population-based registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of mammography screening participation within 90, 180, and 365 d since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation. Results The study comprised 1,828,791 invitations among 847,766 women. Before the pandemic, 80.2% of invitations resulted in participation in mammography screening within 90 d, 82.7% within 180 d, and 83.1% within 365 d. At the start of the pandemic, the participation in screening within 90 d was reduced to 69.9% for those invited in pre-lockdown and to 76.5% for those invited in first lockdown. Extending the length of follow-up time to 365 d only a minor overall reduction was observed (PR = 0.94; 95% CI: 0.93-0.95 in pre-lockdown and PR = 0.97; 95% CI: 0.96-0.97 in first lockdown). A lower participation was, however, seen among immigrants and among women with a low income. Conclusions The short-term participation in mammography screening was reduced at the start of the pandemic, whilst only a minor reduction in the overall participation was observed with longer follow-up time, indicating that women postponed screening. Some groups of women, nonetheless, had a lower participation, indicating that the social inequity in screening participation was exacerbated during the pandemic. Funding The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.
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Affiliation(s)
- Tina Bech Olesen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Henry Jensen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Henrik Møller
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Jens Winther Jensen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional HospitalRandersDenmark
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
| | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University HospitalCopenhagenDenmark
| | - Sisse H Njor
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional HospitalRandersDenmark
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
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Giorgi Rossi P, Carrozzi G, Falini P, Sampaolo L, Gorini G, Zorzi M, Armaroli P, Senore C, Sassoli de Bianchi P, Masocco M, Zappa M, Battisti F, Mantellini P. The impact of the COVID-19 pandemic on Italian population-based cancer screening activities and test coverage: Results from national cross-sectional repeated surveys in 2020. eLife 2023; 12:81804. [PMID: 36734526 PMCID: PMC9934859 DOI: 10.7554/elife.81804] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Background In Italy, regions have the mandate to implement population-based screening programs for breast, cervical, and colorectal cancer. From March to May 2020, a severe lockdown was imposed due to the COVID-19 pandemic by the Italian Ministry of Health, with the suspension of screening programs. This paper describes the impact of the pandemic on Italian screening activities and test coverage in 2020 overall and by socioeconomic characteristics. Methods The regional number of subjects invited and of screening tests performed in 2020 were compared with those in 2019. Invitation and examination coverage were also calculated. PASSI surveillance system, through telephone interviews, collects information about screening test uptake by test provider (public screening and private opportunistic). Test coverage and test uptake in the last year were computed by educational attainment, perceived economic difficulties, and citizenship. Results A reduction of subjects invited and tests performed, with differences between periods and geographical macro areas, was observed in 2020 vs. 2019. The reduction in examination coverage was larger than that in invitation coverage for all screening programs. From the second half of 2020, the trend for test coverage showed a decrease in all the macro areas for all the screening programs. Compared with the pre-pandemic period, there was a greater difference according to the level of education in the odds of having had a test last year vs. never having been screened or not being up to date with screening tests. Conclusions The lockdown and the ongoing COVID-19 emergency caused an important delay in screening activities. This increased the preexisting individual and geographical inequalities in access. The opportunistic screening did not mitigate the impact of the pandemic. Funding This study was partially supported by Italian Ministry of Health - Ricerca Corrente Annual Program 2023 and by the Emilian Region DGR 839/22.
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Affiliation(s)
- Paolo Giorgi Rossi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | - Patrizia Falini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly
| | | | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly
| | - Manuel Zorzi
- Registro Tumori del Veneto, Azienda ZeroPaduaItaly
| | - Paola Armaroli
- Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di TorinoTurinItaly
| | - Carlo Senore
- Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di TorinoTurinItaly
| | - Priscilla Sassoli de Bianchi
- Servizio Prevenzione Collettiva e Sanità Pubblica, Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-RomagnaBolognaItaly
| | | | - Marco Zappa
- Osservatorio Nazionale ScreeningFlorenceItaly
| | - Francesca Battisti
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly
| | - Paola Mantellini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly,Osservatorio Nazionale ScreeningFlorenceItaly
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Farber R, Houssami N, Barnes I, McGeechan K, Barratt A, Bell KJL. Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14647. [PMID: 36429373 PMCID: PMC9691207 DOI: 10.3390/ijerph192214647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Isabelle Barnes
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Centre for Women’s Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan 2308, Australia
- Australian Longitudinal Study on Women’s Health, The University of Newcastle, Callaghan 2308, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J. L. Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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