More cases of advanced breast cancer since COVID-19, study shows

An increase in cases of advanced breast cancer has been linked to breast screening service shutdowns during the COVID-19 pandemic,  a new study from The Australian National University (ANU) shows.

Researchers from the ANU Clinical School, which is based at Sydney Adventist Hospital (“The San”), studied patients with breast cancer diagnosed between July 2019 and June 2022.  The patients were categorised into pre-pandemic, pandemic and post-pandemic groups.

According to the study’s findings, women faced two major challenges during the pandemic. First, many were frightened to attend general practitioner and hospital appointments for fear of catching COVID. Second, the national BreastScreen Australia program was closed during 2020 and 2021 for a total of six months.

According to the researchers, two key concerns emerged as a consequence. During the pandemic 53 per cent of women presented with symptoms that were not detected by mammography. This figure was as high as 57 per cent in the post-pandemic period. Both the pandemic and post-pandemic figures are much higher than the pre-pandemic period, where the figure was 42 per cent.

Alarmingly, there were more patients with advanced breast cancer (stage three or four) in the pandemic and post-pandemic group (8.5 per cent and 7 per cent) compared to the pre-pandemic group (4.6 per cent). Patients also had more chance of the disease spreading to their lymph nodes and developing into stage two breast cancer.

Lead author, ANU Professor John Boyages AM, based at the San Integrated Cancer Centre said the study showed some worrying trends for patients with more aggressive cancers.

 “Aggressive cancers are known to grow more quickly,” he said. 

“For example, for oestrogen receptor-negative tumours, the rate of node-positivity doubled, increasing from 33 per cent to 66 per cent from the pre-to -post-pandemic periods.

“It was not all bad news.  During the same period, there was an increased use of shorter courses of radiation, and we became more experienced in radiation courses as short as one week.

“We also increased the use of more chemotherapy before surgery to work out if a cancer is sensitive to the planned chemotherapy leading to a shift in less mastectomy rates: 33 per cent pre-pandemic versus 24 per cent post-pandemic.”

According to Professor Boyages, the pandemic represented an unprecedented shift in the approach to the screening and treatment of breast cancer, and managing the competing priorities of preventative healthcare and public health presented a unique challenge. 

“The increased probability of having cancer spread to a patient’s lymph nodes and delayed diagnosis is likely to translate into poorer patient outcomes in the longer term,” Professor Boyages said.

“Our study clearly shows government and health authorities need to prioritise cancer screening in future pandemics.”

The study has been published in the ANZ Journal of Surgery.