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：
10544316
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 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10544316
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 Detection Cancer Hospital Cancer Patient Cancer Prognosis Caring Cessation of life Characteristics Data Detection Diagnosis Diagnostic Diagnostic Services Disparity Engineering Epidemiology Ethnic Origin Event Evidence based intervention 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 breast cancer diagnosis breast cancer survival cancer care cancer diagnosis cancer health disparity cancer subtypes combat data standards deprivation economic indicator evidence base follow-up health equity hormone receptor-negative indexing intervention effect lymph nodes malignant breast neoplasm mortality neoplasm registry pandemic disease pandemic impact patient population pre-pandemic 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.

COVID-19大流行导致乳腺癌筛查和诊断的使用急剧减少服务，乳房X线摄影术在最低点最多下降了99％。筛选和其他诊断延迟有可能导致乳腺癌种群分布的变化特征，导致肿瘤较大，更高且更常见的淋巴结阳性 - 所有因素与乳腺癌死亡率升高有关。在观察性研究中，这些影响更为明显在黑人和绝经前妇女中，这表明与大流行有关的乳房分布变化癌症的特征可能会恶化现有的乳腺癌差异。尽管有这些新兴的证据，但仍有几乎没有现实世界的数据可以量化延迟对乳腺癌流行病学的影响的大小。缺乏信息会抑制发展系统的，基于证据的干预措施的能力可能会减少多余的死亡。因此，这项研究的目的是衡量大流行对乳腺癌的流行病学，使用3,780名被诊断为乳腺癌的妇女的数据大流行期间北卡罗来纳州（UNC）医疗中心，UNC REX和Nash UNC医院（2020年3月至 2021年11月），而在同一医院诊断为8,947例乳腺癌患者大流行（2015年3月至2020年2月）。潜在的假设是总体乳腺癌发生率大流行后下降，但在被诊断出肿瘤较差的乳腺癌中预后特征过多。该假设将通过追求以下来评估具体目的：（1）通过比较乳腺癌发病率的大流行与大流行前的变化总体发病率并根据预后特征（例如，诊断时阶段，肿瘤大小，肿瘤等级，淋巴结状态，乳腺癌亚型）；（2）评估大流行与大流行的乳房的差异癌症事件根据社会经济状况的指标（例如，地区剥夺指数，健康保险状态）和与乳腺癌生存分布相关的患者因素（年龄，种族/种族）。这些趋势将使用中断的时间序列分析评估，这是一种方法上严格的方法，允许在测试干预措施的同时，控制大传真趋势。患者癌症诊断和个人信息将从医院的癌症注册表中获得，该注册表抽象高质量标准化在通过其他来源（例如州癌症注册表）公开获得类似数据之前的数据〜6个月，允许及时确定乳腺癌发病率模式的变化。评估大流行对乳腺癌流行病学的影响将有助于识别干预措施（例如，修改对诊断过程，针对受影响的人群亚组的目标，以减少随访的损失等）以减轻与大流行有关的延误在护理方面的影响并减少了可归因于乳腺癌死亡的多余数量大流行。