Breast Cancer Awareness in a Pandemic: The Risks Are Higher
By Debra Wood, RN, contributor
While the COVID-19 pandemic continues unabated, breast cancer is not taking a break. Yet the number of screenings remain down, and concerns exist about poorer outcomes.
“It’s very concerning because we know if we are able to diagnose breast cancer at an earlier stage, we have a greater ability to treat it with, hopefully, less invasive and less aggressive procedures,” said Michelle Tollefson, MD, FACOG, associate professor or lifestyle medicine at Metropolitan State University of Denver and a breast cancer survivor. “We want to identify cancer as early as possible and treat it as early as possible.”
Nora Hansen, MD, a breast surgeon at Northwestern Memorial Hospital in Chicago, reported a decrease in screening mammograms at Northwestern and also expressed concern.
“Clearly, there are breast cancers that are going to be missed,” Hansen said.
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What’s at risk
This summer, Norman Sharpless, director of the U.S. National Cancer Institute, wrote in Science that an additional 5,000 deaths from breast cancer in the next 10 years are likely to occur due to delays in screening.
“Nurses should encourage women to come in and get their screening mammograms and for women with symptoms, make sure they come in,” said Tiosha Bailey, DrPH, MPH, executive director of Susan G. Komen-Chicago, a group that takes a 360-degree approach to breast cancer, including advocacy, funds for services, a reduction in health disparities and research. She added that nurses also can explain to patients the science behind breast cancer and the importance of screening and about COVID-19.
“Nurses can counsel women that they see to get screening for breast cancer,” added Constance M. Chen, MD, a board-certified plastic surgeon and breast reconstruction specialist in New York. “Breast cancer screening can lead to early detection, which leads to improved survival.”
Early in the pandemic, various organizations, including Susan G. Komen, asked women to delay screenings. Facilities needed to preserve personal protective equipment (PPE) and other resources, but since early summer 2020, breast care and imaging centers have reopened.
“We are in a better place now, with greater access to PPE,” Bailey said.
From March to June 2020, about 285,000 women did not receive their breast screenings, according to a report from EPIC Health Research Network.
In a cross-sectional U.S. study, reported in JAMA Network Open, during the pandemic, there was a 51.8 percent decline in breast cancer diagnoses, leading the authors to conclude, “delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes.”
Breast cancer awareness and the pandemic
With the coronavirus pandemic taking center stage, women may not think about breast cancer, but it remains a risk. Hansen encouraged nurses to “try to get patients not to hide in the sand” and to take care of their breast health.
While different guidelines exist, most experts agree that, starting at age 40, women should receive an annual mammogram and a clinical breast exam. Now with COVID-19, for some women, the fear of coronavirus has taken over their desire for preventive care.
“Women tell me they are afraid to come in and are worried about COVID,” Hansen said. “I tell them, we are all worried about COVID, but you also have to be worried about breast cancer.”
Physicians and other experts agree: women should no longer postpone their screening mammograms.
“Hospitals and radiology centers are very safe,” Hansen added.
Physician offices, breast centers and imaging facilities are taking precautions to ensure women can receive screenings at minimal risk of COVID-19. They are requiring masks, cleaning the equipment between patients, taking patients’ temperatures and spacing patients, keeping socially distanced.
“It is reasonable for patients to want to be cautious,” Tollefson said. “But as health professionals, we need to reassure them screening can and should continue to move forward.”
Breast cancer awareness: Modifying the risks
Women can take steps to change modifiable breast cancer risk factors, such as eating more plant-based foods and fiber, increasing physical activity, limiting alcohol consumption, maintaining a healthy weight, stopping smoking, reducing stress, knowing their family history of the disease, and breastfeeding their children. Bailey recommends genetic testing if a family history exists.
“There’s exciting work being done about lifestyle as medicine,” said Tollefson, who serves on the executive board of the American College of Lifestyle Medicine. She added that breast cancer survivors also can benefit from these healthy lifestyle choices.
While somewhat controversial, many experts continue to recommend women perform breast self-exams, even though the literature has shown mixed results.
“I still recommend patients do it,” Hansen said. “More patients than not find their own lumps. The more you are used to what your breast feels like, the more you will be attune to a change.”
However, Hansen said, self-exam is not a substitute for a mammogram.
If a women finds something different in her breasts, she should immediately have a healthcare provider assess it.
Breast cancer and treatment
Once diagnosed with breast cancer, many women have experienced delays in treatment due to COVID-19. Some facilities have been closed to elective surgeries, or were for a period of time, delaying anything that wasn’t needed for an immediate, life-threatening condition.
“During the height of the COVID-19 pandemic, some states prohibited elective surgeries,” Chen said. “Even mastectomies for women with invasive breast cancers were often delayed as the hospitals were overcrowded with COVID patients. During this time, there were no breast reconstructions being performed for several months in some states that were severely affected by COVID-19.”
Chen added that women can continue to receive a breast reconstruction surgery, even after a delay. She recommended nipple-sparing mastectomies and natural tissue reconstruction for an aesthetic outcome.
Bailey encouraged any woman in active treatment for breast cancer to not stop, to stay with the plan and see the treatment process through.
Resources for those going through breast cancer are readily available. Athenex Oncology recently released the free Your Guide to Facing Metastatic Breast Cancer, with evidence-based recommendations for increasing resilience.
“While the Guide was created before the global COVID-19 pandemic struck, its recommendations can be particularly useful during these difficult times, when people with metastatic breast cancer feel even more isolated than usual,” added Beth DuPree, MD, medical director of the oncology service line at Northern Arizona Healthcare in Sedona, vice president of Holy Redeemer Health System in Pennsylvania, and founder and president of the Healing Consciousness Foundation.
COVID-19 also has affected funds raised for breast cancer research, Bailey said. The Chicago chapter of Susan B. Komen has experienced changes in fundraising events.
“There is a growing concern in the cancer community about funding and that some research may need to be paused,” Bailey said. “I have not heard about a big shift in research pausing, but it could be a possibility.”
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