Despite COVID-19, mammography is as important as ever

In the first phase of the coronavirus pandemic, many women decided against going to the doctor and having mammography screenings.  In some places, the number of patients who had their breasts examined dropped by more than two-thirds. The screening centers barely had enough to do. "Practices were sometimes empty," says Vanessa Kääb-Sanyal,  who is the head of the Mammography Cooperative in Berlin.

Hospitals saw much the same decline when the coronavirus pandemic hit. "Early detection screenings, which are not urgent medically, became much rarer in March and April," says Olaf Ortmann  from the University Hospital of Regensburg, who is also president of the German Cancer Society.

Closed until further notice

There was widespread uncertainty among the patients, the assistants who carry out the screenings and even the doctors. On March 25, the Federal Joint Committee (G-BA), the body that takes decisions on routine health care in Germany, decided that no more invitations for mammography screenings would be sent out until the end of April.

All screening units were closed — and not only in Germany. In England, for example, the National Health Service (NHS)  also shut down its mammography units.

Now, however, they are open for business again. And there is lots of catching up to do. Screening units have developed a settled routine once more, 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 infection. 

Unprecedented situation

A few months ago, things were different. During the first peak of the pandemic, patients were not the only ones to be afraid of becoming infected: Medical staff were also exposed to risk during the examinations.

"During mammography screenings, there is close contact between the woman doing the screening and the woman being examined. This is unavoidable. In the initial phase, there was no protective equipment whatsoever," says Kääb-Sanyal. "It was good to interrupt mammography screenings for a while until everyone could adjust to the new situation and both sides could be protected."

Postponing not a major risk

Most women who missed a screening because of the complete closure of the units are now catching up. The earlier a tumor is detected, the greater the chance that treatment will be successful.

Unless doctors discover a lump in the breast by another kind of examination, for example, by palpation (manual examination), screenings for women in the relevant age group should take place about 24 months apart. In Germany, this recommendation applies to women aged from 50 to 69.

Postponing mammography screening for 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 is developing, 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 needed. The carcinoma may already be advanced, which reduces the chances of recovery and treatment options."

She says, however, that by and large such postponements do not have any major impact on women who regularly go for mammography screening.

Weighing up the pros and cons

Researchers and physicians are gradually learning more about COVID-19. However, they have had to review certain conclusions about the disease again and again.

"In the initial phase, we thought that certain cancer therapies, such as chemotherapy, should be carried out very cautiously.  We now see that differently," says Olaf Ortmann. "With the appropriate safety measures, they should be carried out in the same way as they always have been."

Scientists believe that cancer patients are at a higher risk for serious illness if they become infected with the coronavirus. This is especially true of cancers that are associated with suppression of the immune system. "These include hematological diseases, blood cancers or lymph gland cancer, for example. With these, the disruption of the hormonal system is more pronounced than if patients have early-stage breast cancer. That has hardly any relevant influence on the immune system," says Ortmann.

In most cases, the COVID-19 disease must be treated first. It then depends on the individual case whether therapies are postponed, interrupted or completely suspended. Doctors and patients have to weigh up whether the COVID-19 infection or the cancer is worse, and this is often a difficult decision. 

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