The influence of the COVID-19 pandemic on the use of medical imaging during the breast cancer care pathway

The COVID-19 pandemic has had a significant impact on healthcare systems, causing disruptions in various medical services. The aim of this study is to investigate the influence of the COVID-19 pandemic on the use of medical imaging during the breast cancer pathway in the Netherlands. The data is obtained from the Netherlands Cancer Registry and the Dutch Hospital Data. A total of 73,285 patients were included. To analyse the influence of COVID-19 on medical imaging during breast cancer diagnostics, treatment and follow-up, two periods were compared: the COVID period (week 2, 2020 – week 28, 2021) and the pre-COVID period (week 2, 2018 – week 28, 2019). These periods were both divided into five periods: period A till period E. For diagnostics, a Sankey diagram was computed and a Poisson regression was performed on the number of medical imaging events. For treatment, a comparable Poisson regression was performed and for follow-up logistic regression was performed on a yearly follow-up mammogram. Within the first five diagnostic medical imaging events, during the COVID-19 period 76.5% of patients is diagnosed, compared to 29.4% in the pre-COVID period. For treatment, the incidence rate ratios for the utilization of medical imaging across the four therapy types were lower during the COVID-19 period compared to the pre-COVID-19 period, especially in period A, B, and C. Regarding follow-up, the Odds Ratio of a yearly control mammogram being performed in the COVID period is 0.27 (0.23-0.32) during period A, 0.07 (0.06-0.08) during period B, 0.22 (0.20-0.24) during period C, 0.43 (0.39-0.47) during period D, and 1.12 (1.02-1.23) during period E. The study reveals notable changes in medical imaging utilization. During the pandemic, patients were diagnosed after fewer medical imaging events, a decrease was found in the use of medical imaging for monitoring responses to systemic therapies, and a smaller proportion of patients received a follow-up mammogram.