Do Not Delay Breast Cancer Screening
Darcey G., a freelance magazine editor, pushed off her annual mammogram in the fall of 2019 because of a demanding four-month assignment. When the long hours began to ease in late February, the coronavirus was beginning to spread throughout the U.S. and Darcey decided, once again, to delay scheduling the screening test. “I thought, I’m not doing it now,” says Darcey, a runner who never had any serious health problems.
On April 23, at the height of the COVID-19 pandemic in New Jersey, the mother of twin teenagers felt a lump in her left breast. She consulted Atlantic Medical Group Primary Care at Westfield and Summit provider Amy Schram, DO, who referred her to breast surgeon Marc Mandel, MD, MS, FACS, a board-certified surgeon in Atlantic Cancer Care and member of the Breast Program Leadership Committee, Overlook Medical Center.
Early Detection Is Key
Dr. Mandel met Darcey in his office the very next day. A mammogram and ultrasound had revealed a mass in her left breast. Dr. Mandel, along with his staff, who kept seeing patients throughout the pandemic, was able to perform an ultrasound-guided biopsy immediately. Two days later, the biopsy confirmed that the tumor was breast cancer. Further workup revealed that it was likely Stage 1 and a lumpectomy would be necessary. Fortunately for both patient and doctor, Overlook’s operating rooms were operational for urgent cases during the pandemic. “At most major medical centers, patients would have waited six weeks for surgery. Our leadership kept the main OR and the Reeves Same-Day Surgery Center safely open for patients who needed it during that time,” comments Dr. Mandel.
On May 7, just two weeks after feeling the lump in her breast, the 47-year-old Summit resident underwent outpatient surgery, followed by five weeks of radiation. Now, she is cancer-free. “I can’t help but think, it could have been detected earlier,” Darcey says. “And what if I hadn’t found it?”
COVID-19 Impact
Cancer screenings, which can identify tumors early and greatly improve outcomes, dropped off by more than 46% in the early months of the pandemic, according to a study published in the Journal of the American Medical Association.
“We’re still playing catch-up with women who put off getting their mammograms in 2020,” points out Dr. Mandel, “and as a result, we’re seeing more advanced cases of breast cancer.” “Early detection translates to long-term survival as well as minimization of medical and surgical treatments,” says Rebecca C. Yang, MD, FACS, a board-certified surgeon, fellowship-trained in breast surgery and medical director of breast surgery at Overlook Medical Center. “I encourage women to be proactive about their health care, especially during the COVID-19 pandemic. Mammograms are the only breast imaging modality proven to decrease breast cancer mortality.”
Even before the pandemic, a third of women age 40 and over were skipping routine mammograms, says Bonni Guerin, MD, director, Breast Cancer Treatment and Prevention, Carol G. Simon Cancer Center at Overlook Medical Center. “Delaying even one mammogram can translate to cancer being diagnosed at a later stage,” says Dr. Guerin, a board-certified oncologist/hematologist who treated Darcey.
Statistics
Statistics put that in perspective: Among women getting annual mammograms whom doctors diagnosed with breast cancer:
- 76% had a Stage 1 tumor
- 24% had a more serious Stage 2 or higher diagnosis, according to a study.
- The rate for a Stage 2 or higher tumor was twice as high (48%) in women diagnosed after biennial mammograms
Tumor size can play a significant role in cancer severity and the aggressiveness of treatment required to eliminate it, Dr. Guerin notes. The average size tumor identified at an annual mammogram is 1.4 cm versus 1.8 cm found in women who go two years between mammograms, she says. Tumors that develop between screenings are far more likely to occur in women who have biennial mammograms than those tested yearly, studies show. Had Darcey’s tumor been larger, Dr. Guerin said she would have added chemotherapy to the treatment regime.
When to Begin Annual Screenings?
At age 25, women should undergo a formal risk assessment to determine when to begin annual screenings for breast cancer. Women with an average lifetime risk should begin annual screenings at age 40, perform regular self-exams and see their doctor regularly. Women with a strong family history and/or a predicted lifetime risk greater than 20% should consider, in consultation with their primary care physician, other options for risk management. That includes adding screening breast MRI studies, and/or scheduling a referral for genetic counseling and testing.
Women with a documented BRCA1 or BRCA2 mutation should begin getting annual breast MRIs at age 25 and add annual mammograms at age 30. The tests should be staggered, so that one is performed every six months.
The good news is, 90% of women leave their mammograms not needing to return for a year. Only 10% are asked to get follow-up images, and six of those 10 women will get the all clear. Two out of the 10 will be asked to return in six months to keep a close eye on any area of concern. Only the remaining 2% will undergo a biopsy to rule out cancer.
When possible, consider scheduling your screening mammogram before the first dose of the COVID-19 vaccination or four to six weeks after the second vaccine dose. This is because some women who receive the COVID-19 vaccine may develop swollen lymph nodes under the arm where the shot was given. This is a normal immune reaction and is a sign your body is responding to the vaccine. These swollen lymph nodes usually return to normal on their own within a few days or weeks. However, swollen lymph nodes could affect a screening mammography reading.
If you have a breast concern, do not delay your test and inform your mammogram technologist when you had the vaccine.
Hospital Safety Protocols
Darcey recalled the fear she felt when she found the lump and underwent tests confirming it as cancer. The day of her surgery, she had to say goodbye to her husband, Oliver, at the door of the hospital because visitors were not permitted at the height of the pandemic. “That was hard,” she says.
But Darcey’s experiences at Overlook Medical Center went smoothly, thanks in large part to strict safety protocols implemented there.
Employees, patients and visitors are evaluated with temperature checks and screening questions when they enter, and everyone is required to wear masks. Hand sanitizer dispensers are available throughout the buildings. Patients are well-spaced in waiting rooms, and treatment rooms are sanitized between appointments. All patients are tested for COVID-19 prior to surgery.
“Darcey received the same high-quality care in the midst of the COVID-19 pandemic as she would have at any other time,” observes Dr. Mandel, who performed 35 cancer-related surgeries from March 17 through May 31, 2020 (when elective surgeries were put on hold at Overlook and other major medical centers). Our doctors, nurses, anesthesiologists, technicians, and so many other frontline workers were committed to healing patients every day — whether they had cancer or COVID-19.”
“There’s so much trepidation about going to the hospital that people put off tests. But once you’re there, you see it’s fine,” Darcey says. “You have a better chance of getting COVID-19 at backyard gatherings than going for your mammogram!”