The Importance of Breast Cancer Screening and Care During COVID-19 hero image with digital dials, metrics, and graphics

Recognize. Confirm. Recover.

Unlike what we see in the movies, the best pilots aren’t the ones who fly their jets by the seat of their pants – always half-a-second from disaster – narrowly averting one perilous situation only to have flown themselves into another, more treacherous problem. “This is May Day! Repeat: This is May Day!” No, pilots are too cool to panic.

The best pilots constantly cross-check their cockpit instruments, their visual cues, their checklists, the winds, the weather, the radios, and everything else that can be checked and re-checked in order to stay ahead of the aircraft and keep it flying within expected performance parameters and out of danger.  Problems will occur from time to time, but through constant monitoring and thorough preparation, conditions that deviate from the norm can be handled promptly to avoid a chain of events that spiral out of control, leading to disaster.

Recognize. Confirm. Recover.
Aviate. Navigate. Communicate.
Run the regular checks. Read all appropriate checklists.

The current coronavirus pandemic has changed expected operating parameters for all of us. We were not prepared, triggering a chain of events resulting in an enormous impact on lifestyles, livelihoods, and lives in our country and on our planet. But this is not a post about where we’ve been or why. It’s about avoiding the out-of-control spiral. Early in the pandemic, Epic Health Research Network published a study illustrating that preventive cancer screenings in the United States dropped 86% (colon) and 94% (breast and cervical) following COVID-19, with a July update indicating a rise in screenings remaining between 29%-36% lower volumes, not yet near their pre-COVID-19 numbers.

Every two minutes, a woman is diagnosed with breast cancer in the United States. However, most can survive breast cancer if it is found and treated early. At NantHealth, we review treatment plans for cancer patients for all cancer types through our decision support tool, Eviti. Of the hundreds of thousands of treatment plans we have reviewed over the past decade, 24% of these are breast cancer – nearly one in four.

A review of over 12,000 Eviti treatment plans for breast cancer by stage over the past four years shows that we’re pushing the envelope in the wrong direction, as Stage IV breast cancer cases have grown from 21% of plans in 2017 to over 30% of plans as of October 2020. We need to do better. There is a real opportunity for earlier interventions. While we’re focused on the impact coronavirus is having on our lives, we’re not running our regular checks to stay ahead of another problem that might be forming. A study in the National Institutes of Health highlighted the importance of maintaining screening and early detection programs in an effort to prevent thousands of late or missed cases.

As shown in the accompanying chart, relative to previous years, we are treating more breast cancer cases at later stages in 2020 – not earlier.

Breast Cancer Treatment Plans by Stage Graph January 2017 to October 2020
Source: Data from 12,000 Eviti treatment plans for breast cancer by stage over the past four years

In addition to less favorable clinical and survival outcomes in later stage breast cancer than with early-stage diagnosis and treatment, a retrospective comparison of treatment costs for 8,360 women who had undergone breast cancer treatment by Blumen et al., published in “Am Health Drug Benefits” in February 2016 concluded:

“Treating advanced- versus early-stage breast cancer is associated with significant increases in incremental costs. Knowledge of the relevant stage-specific cost data provides support for strengthening programs, such as breast cancer screening, that are designed to shift breast cancer diagnosis to earlier disease stages.”1

In other words, not only were later-stage cancer patients sicker and likely to have more clinical complications, but their treatment costs were also more expensive.

I cannot state with certainty that this observed increase in later-stage treatment of breast cancer is a function of avoiding our regular checks to navigate our way through a pandemic or if it’s something else entirely. However, we still need to fly the aircraft. We still need to take care of ourselves.

Health problems will occur from time to time. Still, through constant monitoring and preparation, conditions that deviate from the norm can be handled promptly to avoid a chain of events that spiral out of control, leading to disaster. Run your checks. Don’t skip your screening visits.

Recognize. Confirm. Recover.

 

1 Blumen H, Fitch K, Polkus V. Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service. Am Health Drug Benefits. 2016 Feb;9(1):23-32. PMID: 27066193; PMCID: PMC4822976.

COVID-19 Resources and Information

Satellite picture of planet earth with the sun glowing over the horizon
Information

Videos, External Links, and More

NantHealth and our payer partners have collaborated to provide a list of resources to help our customers care for patients who may be impacted by COVID-19.

Read more