October is Breast Cancer Awareness Month, but COVID-related fears have driven a national decline in the number of women coming in for breast cancer and other critical screenings. Volume is down by as much as 94% compared to pre-pandemic periods, according to a report issued by the Epic Health Research Network in May.
The trend is particularly worrisome because among American women breast cancer is second only to skin cancers, according to the American Cancer Society. About 276,480 new cases of invasive breast cancer will be diagnosed in women this year, according to ACS, and some 42,170 women will die from it.
Yet even as states began to get a handle on the crisis, the screening numbers remained depressed, warned a follow-up Epic Health report issued in mid-July.
Survivors who didn’t get scared off by COVID-19
From January 2020 through the height of the COVID pandemic in April, Amy Niosi underwent a combination of chemo-therapy, surgery and radiation at the John Theurer Cancer Center —part of Hackensack University Medical Center — to treat her breast cancer. Her sister, Amanda Tasca, was also previously treated there for breast cancer.
“I got a fever at the beginning of April, so my medical oncologist tested me for COVID-19 right away,” said Amy. “Fortu-nately, my test was negative.”
Both sisters underwent double mastectomies performed by Dr. Marson Davidson, who’s affiliated with Hackensack University Medical Center. Despite the pandemic, Amy was confident enough to undergo surgery in early June, followed by five weeks of post-surgical radiation. She is also receiving anti-hormonal therapy and is enrolling in a clinical trial looking at a novel therapy to help lower breast cancer recurrence.
“Since my sister already had surgery, I had an idea of what to expect,” said Amy. “And just like my sister’s, my recovery went very well.”
COVID-19 pandemic fears also didn’t prevent Megan Benson from seeking care. The Galloway resident was 38 and had no known risk factors when she learned she had cancer in March. She had surgery, chemotherapy and radiation treatment at AtlantiCare Cancer Care Institute – a Fox Chase Cancer Center Partner – in the center’s Egg Harbor Township location and completed her final radiation treatment on Oct. 12. Benson, an artisan entrepreneur who created and runs Sheep Farm Felt Flock, shares her cancer journey on social media and has inspired other women – including a young mother from Hawaii – to get screenings and follow-up care in a timely manner.
“The number of cancer screenings has recently begun to rise, but has not yet reached previously expected levels: June 16 weekly volumes remained 29%, 36%, and 35% lower than their pre-COVID-19 levels for breast, colon, and cervical cancer screenings,” it noted. Skipping these important screenings can be deadly, experts warn — and it’s even more tragic since New Jersey health care centers have developed effective ways to keep their patients safe.
“Cancer left untreated can spread to other parts of body, jeopardizing a woman’s life and her overall health and wellbeing,” warned Dr. Neha R. Chawla, medical director, Hematology/Medical Oncology at AtlantiCare Cancer Care Institute, a Fox Chase Cancer Center partner. “The earlier a cancer is detected, the greater the chance of treating it before it spreads.
In addition to precautions like temperature checks, requiring appropriate personal protective equipment for staff and patients, the health care system has expanded options for scheduling primary and specialty care by “adding a new online scheduling option for most AtlantiCare Physician Group providers,” she added.
The organization also installed thermal imaging at entrances to AtlantiCare Regional Medical Center’s Mainland and Atlantic City campuses, the HealthPlex in Atlantic City, and the main facility of its Health Park in Manahawkin. “This scanning helps us quickly identify anyone who might have a fever of 100.4 or greater or who is not wearing a mask,” said Chawla. “We’re also doing in-person and telephonic screenings, depending on the care setting.”
With “very stringent guidelines in place, there’s no reason for people to continue to put off mammograms, ultrasounds and other screenings and procedures,” said Dr. M. Michele Blackwood, chief, section of Breast Surgery at Rutgers Cancer Institute of New Jersey and northern regional director of breast services for RWJBarnabas Health.
Rooms and offices get multiple cleanings, and “patients get a phone call asking about their health before they get here,” she added. “Also, everyone who enters wears a mask, their temperature is taken, and there’s either a lot of spacing in the waiting room, or patients wait in their car until they’re called in. The days of crowded waiting rooms may be gone.”
A safe place
Other health care systems are also committed to safe-visit practices. Hackensack Meridian Health, for example, has specially designated specific entrances at its hospitals for certain procedures and services, and announced it engaged a “nationally recognized, third-party organization” to oversee cleaning and sanitizing efforts, “including the testing of air, water and surfaces to make sure they’re safe for our patients and team members.”
Following CDC guidelines, many health care organizations suspended some screening and other non-emergency procedures in March and April, “but now it’s safe to come back,” said Dr. Lisa Bash, medical director of the Breast Center at Atlantic Health System’s Chilton Medical Center. “Employees and patients are screened for symptoms, their temperatures are taken, and everyone wears a mask.”
Atlantic Health “kept track of people who delayed coming in, called them to follow up, and encouraged them to come in as soon as we got the okay,” Bash noted. “Breast cancer doesn’t stop for COVID-19, but many women now feel comfortable and safe and are coming in.”
The COVID-19 pandemic has also made it “particularly challenging” to reach women and inform them about the need to get screened for breast cancer, according to Suzanne Corson, executive director of Susan G. Komen New Jersey, the local chapter of the global breast cancer research funding organization.
“We usually host in-person educational events across the state throughout the year,” she said. “We would get groups of up to 100 women in front of doctors and other health providers who discussed issues that included screening, survivorship, and reconstruction. The pandemic forced us to pivot to virtual outreach, but phone, email and social media efforts just don’t feel as natural as in-person activities. Still, as a society we’re getting used to it.”
The organization’s efforts include digital interviews with health care professionals focusing on a variety of issues, she added. “We urge women to go for their screening and other appointments, and we play up the safety protocols that are being followed,” Corson noted. “In March, when this all began, we never imagined that in late October we’d still be worried.”
Some groups face greater risks
Some women are more susceptible to breast cancer than others, noted Dr. Deena Mary Atieh Graham, an oncologist at Hackensack Meridian Health’s Hackensack University Medical Center.
“Besides lifestyle impacts, genetics also matter,” she said. “A significant number of Ashkenazi Jewish women [primarily with German ancestry] have mutations in the BRCA1 and 2 genes that increase their risk of getting breast cancer at a young age, and also of getting ovarian and other cancers.”
African-American and Latina women can have higher rates of the aggressive Triple-negative breast cancer, she added. “And even at a similar stage of diagnosis [compared to non-African-Americans and Latinas] their outcomes don’t tend to be as well. We’re investigating this, along with a possible link to how changes to the microbiome [bacteria and other microbes that live in the human intestines and elsewhere] may lead to a predisposition of cancer.”
Socioeconomics may play a role in the risk factors for Triple negative and other breast cancers among African-Americans, Latinas and Filipinos, according to Dr. Lynette Mendoza, a breast surgical oncologist at Holy Name Medical Center. “There are several theories being considered, but one may be an inability to seek out care,” she said. “It has been noted that when breast cancer is discovered among women in underserved areas, it tends to be at a more-advanced stage and is often more difficult to treat.”
Health care institutions are working with a variety of organizations to reach underserved populations. “Some minority women may be at increased risk for certain types of breast cancer, and we’re working with organizations like Sisters Network to connect with them,” said Dr. Deborah Toppmeyer, chief medical officer and director of the Stacy Goldstein Breast Cancer Center and LIFE Center, Rutgers Cancer Institute of New Jersey. Sisters Network Inc. is a national African American breast cancer survivorship organization. “It’s important to try different ways to reach out, she added, “since there’s been a dramatic decrease in all cancer screening since the COVID-19 pandemic — but people need to remain hypervigilant about their health.”
Regardless of ethnicity, the most important thing women can do is to “realize they may be at risk,” cautioned Dr. Shilpi Gupta, a breast oncologist at Atlantic Health System’s Morristown Medical Center. “Educating the patient population about issues like the role of lifestyle, diet, alcohol use, and exercise is also vital.”
Atlantic Health System traditionally reached them by partnering with medical offices, community centers, religious and other nonprofit centers – holding awareness, screening and other programs – “but of course COVID has made that more difficult,” said Gupta. “Now we’ve mounted online meetings with community doctors where we discuss outreach programs. And we work with a variety of organizations – including the American Cancer Society, the African American Wellness Coalition, the Morris/Somerset County Chronic Disease Coalition and the Morris County Office of Hispanic Affairs – to get the word out.”