In a study reported as a research letter in JAMA Oncology, Hahn et al found that the proportion of U.S. patients with breast cancer undergoing annual surveillance imaging was lower in the post– vs pre–COVID-19 period, with no significant difference in recurrence or progression being observed.
Study Details
The study involved data from the Kaiser Permanente Southern California cancer registry on patients with stage 0 to II breast cancer who underwent curative surgery. Patients were categorized into two periods, each with 2 years of surveillance: the pre–COVID-19 period including patients diagnosed between January 2015 and December 2016, with surveillance through December 2019; and the post–COVID-19 period including patients diagnosed between June 2018 and May 2020, with surveillance through May 2023. Surveillance began at 1 year after initial surgery.
Key Findings
The study cohort consisted of 3,042 pre–COVID-19 patients and 3,636 post–COVID-19 patients.
Significantly smaller proportions of post–COVID-19 patients vs pre–COVID-19 patients received surveillance imaging in the first surveillance year (2,829 = 77.8% vs 2,589 = 85.1%; P = .001) and in the second surveillance year (2,896 = 79.6% vs 2,519 = 82.8%; P = .01). In adjusted models, post–COVID-19 patients were 6% less likely to receive imaging (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.92–0.96).
Among all patients, receipt of imaging was significantly more likely among: those who received radiation treatment (OR = 1.13, 95% CI = 1.11–1.15); those who received endocrine therapy (OR = 1.07, 95% CI = 1.04–1.10); and those with in situ (OR = 1.08, 95% CI = 1.05–1.11) or stage I disease (OR = 1.05, 95% CI = 1.03–1.08) vs those with stage II disease. No significant differences were observed in analysis according to insurance type, race/ethnicity, or comorbidity score.
No significant difference in breast cancer recurrence or progression was observed between pre–COVID-19 vs post–COVID-19 patients (91 = 2.7% vs 98 = 2.5%: P = .44).
The investigators concluded: “Fewer patients received annual breast cancer surveillance imaging in the post–COVID-19 period. Breast cancer recurrence was similar between groups. Given the less frequent surveillance in the post–COVID-19 period, cancer recurrence should be evaluated during 5- and 10-year periods as data become available.”
Erin E. Hahn, PhD, MPH, of Kaiser Permanente Research and Evaluation, Pasadena, California, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was funded by the National Cancer Institute. For full disclosures of all study authors, visit jamanetwork.com.
