From Houston Public Media:
Carrie Brinsden has always been a stickler for her yearly breast cancer screening.
She’s seen the disease firsthand because of her family history: Her sister died of breast cancer.
This year, her routine appointment was set at the end of March — until the clinic she had gone to for the last 20 years called to cancel.
Like many breast imaging centers in Houston and nationwide, the clinic shut down temporarily due to the pandemic: On March 26, top breast surgeons and radiologists wrote a letter recommending a nationwide moratorium on breast screening exams as a way to decrease the spread of the coronavirus in the United States.
“It didn’t bother me that it was pushed back, but I did want to stay on top of it,” said Brinsden. “I guess at that point COVID was still the unknown factor and didn’t really know what was happening.”
Now some Houston-area clinics report experiencing as much as a 45% decline in mammograms, compared to pre-pandemic times.
The moratorium allowed healthcare providers the time to create a playbook on how to keep preventative medicine going during the pandemic.
The University of Texas Medical Branch in Galveston closed for three weeks. Dr. Angelica Robinson, a breast imaging radiologist at UTMB’s outpatient clinic, said there were some crucial questions they had to ask themselves before reopening.
“How do we keep the patient safe?” said Dr. Robinson. “How do we keep our colleagues safe? How do we do this in the most effective manner?”
UTMB acquired personal protective equipment, which was in short supply at the time. They also created protocols to screen patients and to stagger appointments so the waiting rooms aren’t full.
Despite those safety measures, not all patients responded immediately to their messages to come back.
“Patients were a bit leery,” Robinson said. “They thought, ‘is this a safe exam to do during this time?’ It is safe. We have now put parameters in place, but when the pandemic first evolved, it was just unclear for many patients continue at that point.”
From March to June, the number of mammograms at the clinic dropped by 70%.
But since then, UTMB has found ways to bring screenings back up. They’ve extended their hours and now open on weekends. By July, the clinic was able to return back to 100% normal capacity.
Not every facility has been able to fully recuperate capacity. The Rose, a nonprofit breast imaging center with two clinics in Houston, has actually seen high demand since they opened back up.
But in order to follow social distancing guidelines, the clinics have returned to only 75% of their full capacity.
“You can’t have people sitting side-by-side any more than you can go to a restaurant that is packed” said Dorothy Gibbons, co-founder of The Rose. “The clinics are the same way.”
Gibbons said they had appointments booked solid for weeks.
Mental health has also played a role in these delays. Dr. Robinson from UTMB said anxiety has been a huge presence in the lives of so many women this year.
“I’ve had patients say, ‘if you find something, I just don’t know if I can mentally deal with that right now,'” said Dr. Robinson.
Another reason patients are still delaying is because many have lost their jobs and their health insurance during the pandemic, which has disproportionately affected communities of color.
“Many of the industries, which were not able to work from home, were in service and other sectors,” Robinson said. “Those sectors do have a higher proportion of minority workers. So in that sense, this could potentially affect those workers who now do not have health insurance.”
Even before the pandemic, research showed that Black women are less likely to detect cancer at an earlier stage than white women. That’s according to a 15 year in-depth analysis by the Centers for Disease Control and Prevention, which found that Black women are 40% more likely to die from breast cancer than white women.
“I do believe that this situation will potentially exacerbate some of the health disparities that we see in minority populations,” said Dr. Robinson.
These barriers, even those put in place for public health and safety, are cause for concern among leaders in the medical field.
In June, The National Institute of Cancer projected more than 5,000 preventable deaths in the next decade due to delayed screenings.
Breast cancer can be a fast moving disease, which is why screenings are recommended on a yearly basis.
“It’s the only thing we have,” said Dorothy Gibbons. “There is no shot to keep you from getting breast cancer. There is no medication you can take right now. So the only thing we’ve got is early detection.”
Dr. Angelica Robinson, at UTMB, said there is still time to make up for the backlog.
“Even in non-pandemic times, people are often a little late,” Robinson said. “So the delay of a few weeks or even a few months typically is not going to change the long term outcome.”
But a delay of a year or two years, she said, is when to start worrying.
In the end, Carrie Brinsden only delayed her screening for two months. And that was really a good call on her part — because her sonogram ended up raising a red flag. She got a biopsy and doctors soon diagnosed her with stage 1 breast cancer.
Brinsden took swift action and got a double mastectomy.
“Given my family history, and with my sister, I wasn’t willing to be timid,” said Brinsden. “I’m going to be as aggressive as I can in treating this.”
She said because they caught the cancer early, she didn’t have to undergo chemotherapy after the surgery.
“Honestly, I cried,” said Brinsden. “I was extremely, extremely relieved.”