In the first phase of the coronavirus pandemic, many women decided not to go to the doctor and mammography screenings. In some places, the number of patients who had their breasts examined fell by more than two-thirds. The screening centers barely had enough to do. “Practices were sometimes empty,” says Vanessa Kaab-Sanyal, who is the head of the Mammography Cooperative in Berlin.
Hospitals saw much the same drop when the coronavirus pandemic hit. Early investigations, which are not medically urgent, became much rarer in March and April Olaf Ortmann of the University Hospital of Regensburg, who is also president of the German Cancer Society.
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There was great uncertainty among the patients, the assistants who perform the screenings and even the doctors. On March 25, the Federal Joint Committee (G-BA), the body that makes decisions about routine health care in Germany, decided that no more invitations for mammography examinations would be sent until the end of April.
All screening units were closed – and not just in Germany. In England, for example, National Health Service (NHS) also closed its mammography units.
However, now they are open for business again. And there is a lot to catch up on. Screening units have again developed a regular routine and are adapting to the new and unfamiliar situation, just as doctors’ surgeries and hospitals have done. For example, there is now more space in the waiting rooms to minimize the risk of contamination.
It was different a few months ago. During the first peak of the pandemic, it was not the only ones who were afraid of becoming infected: medical personnel were also exposed to risks during the studies.
“During mammography examinations, there is close contact between the woman performing the screening and the woman being examined. This is unavoidable. In the initial phase, there was no protective equipment at all,” says Kääb-Sanyal. “It was good to pause mammography exams for a while until everyone could adapt to the new situation and both parties could be protected.”
Procrastination not a big risk
Most of the women who missed a screening due to the complete shutdown of the units are now catching up. The earlier a tumor is detected, the greater the chance that the treatment will work.
Unless doctors detect a breast lump through another type of examination, such as palpation (manual examination), screenings for women in the relevant age group should be performed 24 months apart. In Germany, this recommendation applies to women aged 50 to 69.
Delaying mammography screening by one or two months is usually not a problem and has no far-reaching consequences, says Kääb-Sanyal, but there are exceptions: “If a very aggressive carcinoma develops, it cannot be ruled out that a delay of one to two months will indeed have consequences in certain cases. That is time that would have been necessary. The carcinoma may already be advanced, reducing the chance of recovery and treatment options.”
However, she says this delay generally doesn’t have a major impact on women who have regular mammograms screened.
Weighing the pros and cons
Researchers and doctors are gradually learning more about COVID-19. However, they have had to revisit certain conclusions about the disease time and again.
“In the initial phase, we thought that certain cancer therapies, such as chemotherapy, had to be carried out very carefully. We see that differently now,” says Olaf Ortmann. “With proper safety precautions, they should be performed the same way they always have.”
Scientists believe that cancer patients have a higher risk of serious illness if they become infected with the coronavirus. This is especially true for cancers related to suppression of the immune system. “Among which haematological diseases, blood cancer or lymphoma, for example. As a result, the disruption of the hormonal system is more pronounced than in patients with early-stage breast cancer. That has hardly any relevant influence on the immune system,” says Ortmann.
In most cases, COVID-19 disease must first be treated. It then depends on the individual case whether therapies are postponed, interrupted or completely stopped. Doctors and patients must weigh up whether the COVID-19 infection or the cancer is worse, and that is often a difficult decision.
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