Impact of the COVID-19 Pandemic on Breast Biopsy Delays: Factors Contributing to Disparities Across Prepandemic, Shutdown, and Postshutdown Periods.

Abstract

Background: The coronavirus disease of 2019 pandemic significantly disrupted health care delivery, leading to delays in diagnostic procedures.

Objective: This study aimed to examine the factors associated with delays in time from diagnostic examination to image-guided breast biopsies during the prepandemic, shutdown, and postshutdown periods.

Methods: This retrospective cohort study included 4,415 examinations with a BI-RADS 4 or 5 assessment recommending image-guided biopsy for 4,197 patients at a multisite academic institution from January 1, 2019, to December 31, 2021. Delays in biopsy were assessed across three periods: prepandemic (January 1, 2019, to February 29, 2020, n = 1,551), shutdown (March 1, 2020, to May 31, 2020, n = 170), and postshutdown (June 1, 2020, to December 31, 2021, n = 2,694). Patient factors included age, race, ethnicity, personal or family history of breast cancer, area deprivation index, employment, insurance, and marital status. Clinical factors included BI-RADS assessment and biopsy modality. t Tests, Wilcoxon's rank-sum tests, and univariate and multivariate logistic regression analyses were performed to quantify and identify factors associated with biopsy delay.

Results: The median time to biopsy from diagnostic examination significantly increased between the prepandemic (11 days) and postshutdown (16 days) periods (P < .001). Significant biopsy delays, defined as ≥30 days to biopsy, increased between the prepandemic (9%) and postshutdown (12%) periods (P = .001). Compared with the prepandemic period, same-day biopsies increased in the shutdown period (from 8% to 24%, P < .001) due to institutional implementation of same-day procedures during the shutdown, then sharply declined in the postshutdown period (2%, P < .001). Biopsies were independently more likely to be delayed in the postshutdown period compared with the prepandemic period on multivariate analysis (odds ratio [OR] 1.4, P = .004). In addition to time period, patient factors including age between 60 and 70 years (OR 1.5, P = .020) or ≥70 years (OR 1.9, P = .002), Black (OR 1.6, P < .001) or Asian (OR 1.9, P = .003) race, not having a personal history of breast cancer (OR 1.4, P = .018), being unemployed (OR 1.5, P = .005) or uninsured (OR 2.7, P = .001), being unmarried (OR 1.4, P = .004), and undergoing stereotactic (OR 1.3, P = .013) or MRI (OR 4.7, P < .001) biopsies were significant predictors of delay in the prepandemic and postshutdown periods on multivariate analysis.

Conclusions: Delays in breast biopsies increased between the prepandemic and postshutdown periods. Significant delays were more prevalent among older, racial minority, unemployed, uninsured, and unmarried patients during the study period, with the postshutdown period independently predicting significant delays.

Clinical impact: These findings highlight the need for continued interventions to mitigate the effects of health care disruptions, particularly for vulnerable populations, to ensure timely breast cancer diagnoses during and in the recovery period following future health care crises.