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大幅减少筛查和其他服务的数量下降了 99%。诊断延迟有可能导致乳腺癌人口分布的变化特征，导致肿瘤更大、级别更高、淋巴结阳性的情况更常见——所有因素在观察性研究中，这些影响更为明显。在黑人和绝经前女性中，这表明与流行病相关的乳房分布变化尽管有这些新证据，但癌症特征可能会加剧现有的乳腺癌差异。很少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程度。信息的缺乏阻碍了制定系统性、基于证据的干预措施的能力，因此，本研究的目的是衡量大流行对人们的影响。乳腺癌的流行病学，使用来自 3,780 名在大学诊断患有乳腺癌的女性的数据北卡罗来纳州 (UNC) 医疗中心、北卡罗来纳大学雷克斯分校和纳什北卡罗来纳大学医院在大流行期间（2020 年 3 月至 2021 年 11 月），相比之下，同一家医院在此之前诊断出 8,947 名乳腺癌患者大流行（2015 年 3 月至 2020 年 2 月）的基本假设是总体乳腺癌发病率。随后，大流行的发病率有所下降，但在被诊断出的乳腺癌中，肿瘤的预后较差预后特征被过度描述。该假设将通过以下内容进行评估。具体目标：（1）通过比较来评估乳腺癌发病率与大流行前的变化总体发病率和预后特征（例如诊断分期、肿瘤大小、肿瘤分级、淋巴结状况、乳腺癌亚型）；以及（2）评估乳腺癌大流行与大流行前的差异根据社会经济状况指标（例如，地区剥夺指数、健康保险状态）和与乳腺癌生存差异相关的患者因素（年龄、种族/民族）这些趋势。将使用中断时间序列分析进行评估，这是一种方法论上严格的方法，允许控制大流行前的趋势，同时测试患者癌症诊断和干预的效果。个人信息将从医院癌症登记处获得，该登记处提取高质量、标准化的信息数据在类似数据通过其他来源（例如国家癌症登记处）公开之前约 6 个月，以便及时识别乳腺癌发病模式的变化，评估大流行的情况。对乳腺癌流行病学的影响将有助于确定干预措施（例如，修改诊断过程、针对受影响的人口亚群以减少随访损失等）以缓解与大流行相关的护理延误的影响并减少乳腺癌过量死亡的人数到大流行。