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Impact of the COVID-19 pandemic on newly-diagnosed breast cancer

COVID-19 大流行对新诊断乳腺癌的影响

基本信息

批准号：
10359555
负责人：
Sarah Jane Nyante
金额：
$ 7.78万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10359555
关键词：
Address Affect Age American Joint Committee on Cancer Area Biometry Black race Breast Cancer Detection Breast Cancer Epidemiology Breast Cancer Patient COVID-19 COVID-19 pandemic COVID-19 pandemic effects Cancer Burden Cancer Hospital Cancer Patient Cancer Prognosis Caring Cessation of life Characteristics Data Detection Diagnosis Diagnostic Diagnostic Services Engineering Epidemiology Ethnic Origin Event Evidence based intervention Gold Health Health Insurance Healthcare Systems Height Hospitals Incidence Infection Institution Insurance Insurance Coverage Interruption Intervention Knowledge Lead Link Malignant Neoplasms Mammographic screening Mammography Measures Medical center Medicine Methodology Methods Mission Modification Morbidity - disease rate Neighborhoods Newly Diagnosed North Carolina Observational Study Oncology Outcome Pathology Patients Pattern Population Population Distributions Population Heterogeneity Positive Lymph Node Premenopause Process Prognosis Public Health Race Radiology Specialty Reporting Research Series Socioeconomic Factors Socioeconomic Status Source Stage at Diagnosis Subgroup Symptoms Testing Time Time Series Analysis Tumor stage United States National Academy of Sciences Universities Woman attributable mortality base breast cancer diagnosis breast cancer survival cancer care cancer diagnosis cancer health disparity cancer subtypes combat data standards deprivation evidence base follow-up health equity hormone receptor-negative indexing intervention effect lymph nodes malignant breast neoplasm mortality neoplasm registry pandemic disease patient population prognostic racial disparity receptor screening screening services socioeconomics survival disparity trend tumor tumor diagnosis

项目摘要

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.

2019冠状病毒病大流行导致乳腺癌筛查和诊断的使用大幅减少