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Double-digit drops in mammography worry experts about deaths to come

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Cincinnati Enquirer

For years, Dana Spradling of the Cincinnati suburb of Maineville joined the nearly 65% of American women who got annual mammograms to screen for breast cancer. This year, she did not allow the uncertainties of the new coronavirus pandemic to deter her.

The May appointment, she said, was “a piece of normal.”

As she sheltered in place at home for months, Cindy McDonald of the Summit County city of New Franklin delayed a mammogram and other medical care. Friday, she finally got the cancer screening. “I just decided to suck it up and make all of my appointments,” she said.

Though more women are getting back on their mammogram schedules through the pandemic, alarmed cancer experts said Ohio and the nation now are caught in an unprecedented experiment with dangerous consequences.

[Please support The Enquirer’s coverage of the coronavirus pandemic with a subscription.]

The pandemic has nearly undone decades of effort – pink-ribbon 5K runs to raise research money, awareness campaigns anchored in October since 1985, ultimately better insurance coverage of mammography – to persuade women not to forget about the one tool that finds breast tumors early, when they are most treatable and survivable.

Although mortality has dropped over the past 30 years, breast cancer remains the second-leading cause of cancer deaths for Ohio women after lung cancer. The Ohio Department of Health reports that in 2016, 1,710 women and 18 men died of breast cancer.

Mammograms are recommended every two years for women 50 to 74 at average risk for breast cancer. Women 40 to 49 should talk to their health care professionals about when to start and how often to get a mammogram.

The U.S. Centers for Disease Control and Prevention has set a goal of 80% of women getting mammograms. By 2015, the rate was about 65% overall.

But the pandemic slammed preventive medicine, and health systems now report startling decreases in mammography. UC Health reports mammography remains down 43% as of early October even though nonessential services, including cancer screening, resumed May 1 across Ohio.

“People have to balance the risks of coming out of their homes,” said a “quite worried” Dr. Mary Mahoney, chief of imaging at UC Health. “But for those people who are resuming normal activities, going to work, going to restaurants, going to social events: Where does taking responsibility for your own personal health fall into this?”

Bon Secours Mercy Health is down 25% in mobile screenings in 2020 over 2019, said spokeswoman Nanette Bentley. In Clermont County alone between March and September, more than 2,700 Mercy Health patients have missed their annual mammograms.

Dr. Abigail Tremelling, a Mercy Health breast surgical oncologist in the Eastgate Medical Center, said, “My biggest concern is that we know that mammography saves lives. The earliest way to diagnose breast cancer is before you feel a mass in your breast. I’m worried we’ll see more advanced cancers the longer that people delayed this important test.”

Epic, the electronic medical records company, reported in July that nationally, breast cancer screenings were still nearly 30% below what would be expected by that month in any other year. In June, the chief of the National Cancer Institute warned that forecast models show an additional 10,000 Americans will die just of breast and colorectal cancer in the next 10 years due to the delays in screenings.

Black women are at particular risk for breast cancer. The American Cancer Society finds they are likelier than white women to get breast cancer before 40 and more likely to die of it at any age. Buckeye Health Plan, which covers many Medicaid and Medicare patients, has combatted the pandemic delays in mammography by paying patients’ transportation costs and an incentive of between $50 and $75.

“We do a lot to encourage mammograms,” said Monique Gladden, a registered nurse in charge of Buckeye Health Plan’s member outreach. “We are working with individuals to overcome barriers. Transportation is a big barrier, so we often that assistance or help with coordinating other issues.”’

McDonald, 67, a retired high school principal, hunkered down through the spring and summer. She keeps a wary eye on the case numbers for the coronarvirus as she checks off the mammogram and other screenings from her to-do list. “For so long, we were scared. We didn’t want to go to restaurants or go shopping. I just started to get a little bit more confident. And now, it’s all back again and I’m thinking:  Get in there, get it done and get out.” 

Spradling, an organizational consultant who is 53, said scheduling her mammogram in May gave her a sense that “I am in control and in charge of the choices that I make” in navigating the pandemic’s “daily series of unknowns.”

“The unknown is where the fear has settled in,” she said. “The human condition doesn’t deals with the unknown very well.”

Betty Lin-Fisher of the Akron Beacon-Journal contributed.

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https://www.cincinnati.com/story/news/2020/10/19/mammography-breast-cancer-pandemic-decreases-excess-deaths/3669643001/

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