Spurred by a pandemic, doctors try to make breast cancer screening easier

But to my surprise, Morrison soon realized that additional testing was needed, and what he heard next surprised her even more. “I can do it today.” She moved from screening to further tests and biopsies in 4 to 5 hours. She has completed surgery and radiation treatment since she was diagnosed with a very early stage cancer.

“This is a godsend, and you don’t have to wait or suffer for weeks,” Morrison said.

Prompt diagnosis was also an unexpected benefit of the pandemic. To make up for the mammogram that was overlooked during the blockage, doctors have been looking for ways to bring the patient back for treatment.

Like a storm blowing shingles off an abandoned roof, the pandemic exposed the weaknesses of the medical system. Most surprisingly, it highlights the inequality that has long impaired the health of blacks, Hispanics, and people with low socioeconomic status, such as Morrison.

The pandemic also shook hidden practices and promoted changes that many patients might consider to be longer delinquent, such as adopting the convenience of telemedicine. And it reduces the pain of mammography waiting time.

“We listen to patients and try to ask ourselves,” What do patients need? ” He thinks out of the box and rejects those beliefs — “it’s not the way we do things.” Dr. Constance D. Lehman, Director of Breast Imaging at Massachusetts General Hospital and Co-Director of Comprehensive Breast Assessment at the AVON Foundation

Cancer screening of all types has decreased dramatically during the pandemic, including testing for breast, colon, cervical, and lung cancer. Screening tests were completely discontinued for approximately 3 months, when all selective treatments were discontinued.

However, the mammography center was reopened in the summer, so it has not yet made up for all the exams that were absent. Many women have not changed their schedule. Others continue to hesitate to come to the medical field for fear of infection.

Epic Health Research Network, a journal that analyzes electronic medical record data, found Cancer screening has recovered after the sharp drop in the spring of 2020, but the numbers have not completely caught up. Looking at screenings from March 2020 to March 2021, the journal found that breast cancer screening was 13% lower than historical averages, colon cancer screening was 25% lower, and cervical cancer screening was 21%. Reported low.

Another study, published on June 30, found that resumption of screening was unequal in one large hospital system.The· ResearchExamining only the experience of the Mass General Brigham Hospital Group, we found that fewer black and Hispanic women received mammograms in the last quarter of 2020 compared to three months before the pandemic. .. At the same time, the number of white women getting mammograms increased.

Lehman saw evidence in her own practice. More women are coming to imaging centers that tend to serve white non-Hispanic women, and fewer women are traditionally screened at centers that serve Hispanics and people of color.

She also identified another disparity in her own practice: unintended favors.

Usually, when a woman gets a mammogram, the x-rays are grouped with others who perform during the day. The radiologist will read them the next day. If there seems to be any doubt, such as less than a tenth of a mammogram, the woman will receive a call or letter within a few days and will return for another mammogram.

However, Lehman found that about 15% of patients could read the mammogram immediately. This is often because the patient is a strong self-assertive or the doctor asks the radiologist. And studying the data, she found that they were white women with higher incomes.

“It was shocking to see it. We unintentionally developed this system to support inequality,” Lehman said.

Women who are least likely to be “ready to read” may encounter other obstacles, such as inflexible work schedules, transportation and childcare issues, and have difficulty returning. This can lead to delayed diagnosis. And, for a long time, studies show that black women are more likely to die of breast cancer than white women, even though the incidence of breast cancer is similar.

Lehman and her colleagues wanted to find a better way. Mass as soon as the Imaging Center reopened in June 2020. General immediately began to provide results to patients. The number of patients receiving immediate reading increased from 15% to 60%. (Lehman is studying what happened in the other 40%. Perhaps some patients preferred to come back, or the staff took too long to provide results. maybe.)

But most importantly, the racial and ethnic disparities have disappeared. Immediate results were provided equally to all.

The hospital has also launched a “pink card” program for women visiting Boston clinics for some reason. If you plan to have a mammogram, you will receive a pink card and take it to a nearby imaging center for inspection for the day.

The instant reading program has been Mass in two image centers since 2017. It is based on another improvement provided by General. A biopsy performed on the same day or immediately after a follow-up test indicates the need to examine a tissue sample of cancer cells.

These advances allowed 52-year-old Amy Federico, who lives in Charlestown, to complete a process that would otherwise have been a week’s ordeal in the morning of the day.

After her annual mammogram in June 2020, she soon learned that something was worrisome. The doctor performed a follow-up mammogram and was still worried and advised Federico that he wanted to have an ultrasound. And a biopsy.

A few days later she received a call. The small nodules that appeared in the image were benign.

Federico, 52, an oncology nurse at Children’s Hospital in Boston, said:

In reviewing screening procedures, hospitals have used lessons from other industries, such as restaurants and hotels, to address unpredictable customer demand. Lehman and her team sought to emulate the customer-first practices of these companies, eliminating delays and waste, standardizing procedures, and streamlining workflows.

“There will be 12 different doctors who wanted to set up the room in 12 different ways,” she said. But if all doctors follow the same steps, things will be smoother.

All mammograms from the six imaging centers are electronically sent to a central location to prevent distracted radiologists in busy clinics from reading scans.

The Dana-Farber / Brigham and Women’s Cancer Center also promises results on the same day, but patients don’t have to wait to avoid congestion in the waiting room, said Dr. Sona Chikarmane, director of breast imaging. .. If the mammogram was taken before 3 pm, the woman will receive the call by 3 pm. Also, the appointment remains open for callbacks so the patient does not have to wait long.

The effects of a pandemic raise some major issues as healthcare providers struggle to make up for missed screenings.

Will there be a surge in late-stage cancer and deaths from cancer? Or does it make no difference if the screening fails and confirms the critics’ view that all this test is worthless?

Anecdotally, doctors report an increase in more advanced cancers. Some may result from patients who have symptoms but are afraid to seek help during the pandemic. This is different from skipping screening tests. Screening tests, by definition, are aimed at people who are asymptomatic and most people do not have cancer. Most cancers grow slowly, so it takes years to assess the effects of skipping or delaying screening.

Dana-Farber Breast Cancer Expert Dr. Ann H. Partridge said a three-month delay probably wouldn’t make a difference to breast cancer. Still, doctors are worried about the cancers that may have been found in these missed mammograms. Will they be in time?

“What we are concerned about is that people wait a year, a few years,” she said. “We are worried about people who will not come back to return to the screening regimen.”

However, renowned critic of unnecessary screening, Dr. H. Gilbert Welch, said the screening backlog impacts breast cancer mortality because treatment has improved significantly and can be managed even in late-stage breast cancer. States that he is not thinking. Welch, a member of the Brigham and Women’s Center for Surgery and Public Health, said he would invest heavily in looking for illness in the well “while not paying attention to the stronger determinants of health.” I questioned my wisdom.

But Mass. Lehman of General holds the mainstream view. “Mammography screening has repeatedly proven to be the best tool needed to reduce breast cancer mortality.”

And she says she is committed to making mammography easier for all women.

“I’m not going to go back to what it was before,” she said. “We learned a lot. We will move it forward.”

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You can access Felice J. Freyer at the following URL: [email protected].. Follow her on Twitter @felicejfreyer..